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Monteiro J, Balmer R, Lafferty F, Lyne A, Mighell A, O'Donnell K, Parekh S. Establishment of a clinical network for children with amelogenesis imperfecta and dentinogenesis imperfecta in the UK: 4-year experience. Eur Arch Paediatr Dent 2024; 25:85-91. [PMID: 38308725 PMCID: PMC10943134 DOI: 10.1007/s40368-023-00859-2] [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] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/13/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Amelogenesis imperfecta (AI) and dentinogenesis imperfecta (DI) are two groups of genetically inherited conditions resulting in abnormal enamel and dentin formation, respectively. Children and young people may be adversely affected by these conditions, with significant reduction in oral health related quality of life. Dental management of children with AI and DI is often complex, which is exacerbated by the absence of clear referral pathways and scarce evidence-based guidelines. METHOD The need for increased knowledge and peer support led to the development of a group of UK paediatric dentists with a special clinical interest in the management of children with AI and DI. PURPOSE The aims of this paper are to describe the establishment of an AI/DI Clinical Excellence Network (AI/DI CEN) in paediatric dentistry including outputs and future plans, and to share our collective learning to help support others anywhere in the world advance the care of people with AI or DI.
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Affiliation(s)
- J Monteiro
- Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK.
| | - R Balmer
- School of Dentistry, The University of Leeds, Leeds, UK
| | | | - A Lyne
- RNENTEDH, University College London Hospitals, London, UK
| | - A Mighell
- School of Dentistry, The University of Leeds, Leeds, UK
| | | | - S Parekh
- UCL Eastman Dental Institute, London, UK
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Parekh S, Ochotny R, Lazow SP, Ben-Ishay O, Aribindi V, Pluchinotta FR, Tworetzky W, Buchmiller TL, Peyvandi S, Moon-Grady AJ. High prevalence of left superior vena cava and congenital heart disease in patients with pre- and postnatally diagnosed esophageal atresia/tracheoesophageal fistula. Ultrasound Obstet Gynecol 2023; 62:439-440. [PMID: 36929674 DOI: 10.1002/uog.26202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Affiliation(s)
- S Parekh
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - R Ochotny
- Department of Palliative Care, Akron Children's Hospital, Akron, OH, USA
| | - S P Lazow
- Department of Surgery, Boston Children Hospital/Harvard Medical School, Boston, MA, USA
| | - O Ben-Ishay
- Department of General Surgery, Ramban Healthcare Campus, Haifa, Israel
| | - V Aribindi
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - W Tworetzky
- Department of Surgery, Boston Children Hospital/Harvard Medical School, Boston, MA, USA
| | - T L Buchmiller
- Department of Surgery, Boston Children Hospital/Harvard Medical School, Boston, MA, USA
| | - S Peyvandi
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - A J Moon-Grady
- Division of Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
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Duggal M, Gizani S, Albadri S, Krämer N, Stratigaki E, Tong HJ, Seremidi K, Kloukos D, BaniHani A, Santamaría RM, Hu S, Maden M, Amend S, Boutsiouki C, Bekes K, Lygidakis N, Frankenberger R, Monteiro J, Anttonnen V, Leith R, Sobczak M, Rajasekharan S, Parekh S. Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document. Eur Arch Paediatr Dent 2022; 23:659-666. [PMID: 36219336 PMCID: PMC9637614 DOI: 10.1007/s40368-022-00718-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
Purpose The European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth. Methods Three expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified. Results There is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates. Conclusion The management of deep carious lesions in primary teeth can be challenging and must consider the patient’s compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.
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Affiliation(s)
- M Duggal
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - S Gizani
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian, University of Athens, Athens, Greece
| | - S Albadri
- School of Dentistry, Unit of Oral Health, University of Liverpool, Liverpool, UK
| | - N Krämer
- Department of Paediatric Dentistry, Justus-Liebig University Gießen, Giessen, Germany
| | - E Stratigaki
- Department of Pediatric Oral Health and Orthodontics, University Center of Dental Medicine, Basel, Switzerland
| | - H J Tong
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - K Seremidi
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian, University of Athens, Athens, Greece
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | - A BaniHani
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - R M Santamaría
- Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - S Hu
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - M Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - S Amend
- Department of Paediatric Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen) Medical Centre for Dentistry, Schlangenzahl 14, 35392, Giessen, Germany
| | - C Boutsiouki
- Department of Paediatric Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen) Medical Centre for Dentistry, Schlangenzahl 14, 35392, Giessen, Germany
| | - K Bekes
- Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria
| | - N Lygidakis
- Lygidakis Dental Clinic (Private Dental Practice), 2 Papadiamantopoulou str. & Vasilissis Sofias Ave, 11528, Athens, Greece
| | - R Frankenberger
- Medical Centre for Dentistry, Department of Operative Dentistry and Endodontics, Phillips-University Marburg, University Medical Centre Giessen and Marburg (Campus Marburg), Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - J Monteiro
- Department of Paediatric Dentistry, Sheffield Teaching Hospitals, Sheffield, UK
| | - V Anttonnen
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - R Leith
- Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - M Sobczak
- Specialized Dental Practice, Warsaw, Poland
| | - S Rajasekharan
- Department of Paediatric Dentistry, School of Oral Health Sciences, Ghent University, B-9000, Ghent, Belgium
| | - S Parekh
- Department of Paediatric Dentistry, UCL Eastman Dental Institute, London, UK.
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Wood K, Lyne A, O'Donnell K, Brown CJ, Parekh S, Monteiro J. Patient-reported outcome measures for children and adolescents having dental bleaching in the UK. Eur Arch Paediatr Dent 2022; 23:579-586. [PMID: 35713847 PMCID: PMC9204681 DOI: 10.1007/s40368-022-00721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/17/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE Dental bleaching in paediatric patients can be used to address discolouration of teeth due to trauma, endodontic treatment, or enamel and dentine defects. Despite being a minimally invasive and successful treatment, the use of bleaching products in children and young people remains controversial. This evaluation was designed to provide insight into the child's perspective on dental bleaching and the influence that this treatment has upon their life. METHOD A dental bleaching patient reported outcome measure (PROM) was developed and piloted in 2019. Data were collected from 3 UK units (January-March 2020). Children attending these units for bleaching reviews were invited to complete the PROM. RESULTS Twenty seven PROM questionnaires were completed including 19 courses of external bleaching and 8 courses of internal/external bleaching. The average age was 14 years old (9-17 years). The common indications for bleaching were Amelogenesis Imperfecta, dental trauma and Molar Incisor Hypomineralisation. Patients reported improvements in their appearance (89%) and self-confidence (81%). Sensitivity was the most common side effect, reported in 63% of cases. CONCLUSION This PROM supports the use of dental bleaching in children and young people when treating dental disease that causes discolouration. Bleaching not only improved the appearance of teeth, but also patients' self-confidence. Sensitivity is a common side effect and clinicians should discuss this common risk and its management with patients and their families.
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Affiliation(s)
- K Wood
- King's College Hospital NHS Foundation Trust, London, UK.
| | - A Lyne
- Royal National ENT and Eastman Dental Hospitals, London, UK
| | - K O'Donnell
- Newcastle Dental Hospital, Newcastle upon Tyne, UK
| | - C J Brown
- Birmingham Dental Hospital and School of Dentistry, Birmingham, UK
| | - S Parekh
- Department of Paediatric Dentistry, UCL Eastman Dental Institute, London, UK
| | - J Monteiro
- Charles Clifford Dental Hospital, Sheffield, UK
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Madduri D, Parekh S, Campbell T, Neumann F, Petrocca F, Jagannath S. Anti-BCMA-CAR-T-Zell-Therapie bei einem Patienten mit rezidiviertem und refraktärem Multiplen Myelom nach einer COVID-19-Infektion: ein Fallbericht. Kompass Onkol 2022. [PMCID: PMC9059054 DOI: 10.1159/000522435] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hintergrund: Über das Risiko einer Virusinfektion mit dem schweren akuten Atemwegssyndrom Coronavirus 2 (SARS-CoV-2) bei Krebspatienten, von denen viele immungeschwächt und damit anfälliger für eine Vielzahl von Infektionen sind, ist sehr wenig bekannt. Als Vorsichtsmaßnahme haben viele klinische Studien während der ersten Welle der weltweiten Pandemie des neuartigen Coronavirus (COVID-19) die Aufnahme von Patienten pausiert. In diesem Fallbericht beschreiben wir die erfolgreiche Behandlung eines Patienten mit rezidiviertem und refraktärem Multiplem Myelom (MM), der unmittelbar nach der klinischen Genesung von COVID-19 mit einer chimären Antigenrezeptor (CAR)-T-Zelltherapie mit Anti-B-Zellreifungsantigen (BCMA) behandelt wurde. Fallvorstellung: Der 57-jährige weiße männliche Patient war seit 4 Jahren an MM erkrankt und galt bei der Vorstellung zur CAR-T-Zelltherapie als pentarefraktär. Er hatte eine Immunsuppression in seiner medizinischen Vorgeschichte und er erhielt am Tag vor der COVID-19-Diagnose eine Dosis lymphdepletierender Chemotherapie (LDC). Dieser Patient konnte eine erhebliche Immunantwort gegen das SARS-CoV-2-Virus aufbauen, und antivirale Antikörper bleiben auch 2 Monate nach Erhalt einer Anti-BCMA-CAR-T-Zelltherapie noch nachweisbar. Die kürzliche SARS-CoV-2-Infektion bei diesem Patienten führte nicht zu einer Exazerbation des CAR-T-assoziierten Zytokin-Freisetzungssyndroms (CRS) und umgekehrt führte die CAR-T-Zelltherapie nicht zu Komplikationen im Zusammenhang mit COVID-19. Einen Monat nach der CAR-T-Zell-Infusion wurde bei dem Patienten ein unbestätigtes partielles Ansprechen nach den Kriterien der International Myeloma Working Group (IMWG) festgestellt. Schlussfolgerung: Unser Fall liefert einen wichtigen Kontext für die Wahl der Behandlung von MM-Patienten in Zeiten von COVID-19 sowie für die Frage, ob die CAR-T-Therapie auch bei Patienten verabreicht werden kann, die von COVID-19 genesen sind. Da die COVID-19-Pandemie weltweit anhält, ist eine umfangreiche Diskussion über die Entscheidung, ob mit der CAR-T-Zelltherapie fortgefahren werden soll, erforderlich, wobei die potenziellen Risiken und Vorteile der Therapie gegeneinander abgewogen werden müssen. Dieser Fall legt nahe, dass es möglich ist, die Anti-BCMA-CAR-T-Zelltherapie nach der Genesung von COVID-19 erfolgreich abzuschließen. Die Studie CRB-402 wurde am 6. September 2017 bei clinicaltrials.gov registriert (NCT03274219).
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Affiliation(s)
- D. Madduri
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- *D. Madduri,
| | - S. Parekh
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - F. Neumann
- bluebird bio, Cambridge, Massachusetts, USA
| | | | - S. Jagannath
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Shankar V, Haritha C, Shreya VS, Parekh S, Kumar R, Karthikayan A, Bhavya P, Vyas H, Bhange A. Post SRS Target Diffusion Metrics for Response Prognostication in Idiopathic Trigeminal Neuralgia. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.440] [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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Shreya V, Shankar V, Parekh S, Haritha C, Kumar R, Karthikayan A, Adhityan R, Bhavya P, Vyas H, Bhange A. Post SRS Reversal of Masticator Muscles Atrophy in Idiopathic Trigeminal Neuralgia. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Einsele H, Parekh S, Madduri D, Santomasso B, Pérez-Larraya JG, Donk NWV, Arnulf B, Mateos M, Braganca KC, Varsos H, Carrasco-Alfonso MJ, Akram M, Lendvai N, Jackson CC, Olyslager Y, Zudaire E, Li C, Geng D, Jakubowiak A, Cohen A. INCIDENCE, MITIGATION, AND MANAGEMENT OF NEUROLOGIC ADVERSE EVENTS IN PATIENTS WITH MULTIPLE MYELOMA TREATED WITH CILTACABTAGENE AUTOLEUCEL (CILTA-CEL) IN CARTITUDE-2. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.447] [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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Griffiths F, Parekh S. Is it time to reconsider the use of vital teeth bleaching in children and adolescents in Europe? Eur Arch Paediatr Dent 2021; 22:759-763. [PMID: 33666898 DOI: 10.1007/s40368-021-00609-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to determine whether carbamide peroxide is effective in bleaching vital permanent teeth in children. METHODS A literature search was conducted using all keywords relevant to the research subject. The outcome measures were identified as colour change, tooth sensitivity, oral irritation and patient satisfaction. The certainty of evidence for each outcome was assessed using the current GRADE guidelines. RESULTS Of 115 potentially relevant articles, 112 were excluded, as they did not exclusively involve children, intervention involved additional treatment such as microabrasion or restorative work, or case studies. Patient satisfaction was not assessed in the three articles so no analysis could be made with regards to this outcome. The GRADE assessment showed that all of the three articles demonstrated very low certainty of evidence for the other assessed outcomes. The overall findings from the studies suggest that a 10% carbamide peroxide overnight tray system is effective at bleaching vital permanent teeth in children and associated tooth sensitivity and oral irritation are found to be in a similar range compared to those reported in adult studies. However, due to the very low certainty of the evidence, it is not possible to draw these conclusions. CONCLUSION Better quality randomised controlled trials are needed to investigate the indication, short and long term effectiveness and side effects of carbamide teeth in vital permanent teeth in children.
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Affiliation(s)
- F Griffiths
- Eastman Dental Institute, University College London, 123 Grays Inn Road, Holborn, London, WC1X 8LT, UK.
| | - S Parekh
- Eastman Dental Institute, University College London, 123 Grays Inn Road, Holborn, London, WC1X 8LT, UK
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10
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Madduri D, Parekh S, Campbell TB, Neumann F, Petrocca F, Jagannath S. Anti-BCMA CAR T administration in a relapsed and refractory multiple myeloma patient after COVID-19 infection: a case report. J Med Case Rep 2021; 15:90. [PMID: 33608053 PMCID: PMC7894235 DOI: 10.1186/s13256-020-02598-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Very little is known about the risk that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection poses to cancer patients, many of whom are immune compromised causing them to be more susceptible to a host of infections. As a precautionary measure, many clinical studies halted enrollment during the initial surge of the global Novel Coronavirus Disease (COVID-19) pandemic. In this case report, we detail the successful treatment of a relapsed and refractory multiple myeloma (MM) patient treated with an anti-B cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T cell therapy immediately following clinical recovery from COVID-19. CASE PRESENTATION The 57 year old Caucasian male patient had a 4-year history of MM and was considered penta-refractory upon presentation for CAR T cell therapy. He had a history of immunosuppression and received one dose of lymphodepleting chemotherapy (LDC) the day prior to COVID-19 diagnosis; this patient was able to mount a substantial immune response against the SARS-CoV-2 virus, and antiviral antibodies remain detectable 2 months after receiving anti-BCMA CAR T cell therapy. The recent SARS-CoV-2 infection in this patient did not exacerbate CAR T-associated cytokine release syndrome (CRS) and conversely the CAR T cell therapy did not result in COVID-19-related complications. One month after CAR T cell infusion, the patient was assessed to have an unconfirmed partial response per International Myeloma Working Group (IMWG) criteria. CONCLUSION Our case adds important context around treatment choice for MM patients in the era of COVID-19 and whether CAR T therapy can be administered to patients who have recovered from COVID-19. As the COVID-19 global pandemic continues, the decision of whether to proceed with CAR T cell therapy will require extensive discussion weighing the potential risks and benefits of therapy. This case suggests that it is possible to successfully complete anti-BCMA CAR T cell therapy after recovery from COVID-19. CRB-402 study registered 6 September 2017 at clinicaltrials.gov (NCT03274219).
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Affiliation(s)
- D. Madduri
- grid.59734.3c0000 0001 0670 2351Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1185, New York, NY 10029 USA
| | - S. Parekh
- grid.59734.3c0000 0001 0670 2351Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1185, New York, NY 10029 USA
| | | | - F. Neumann
- grid.434678.a0000 0004 0455 430Xbluebird bio, Cambridge, MA USA
| | - F. Petrocca
- grid.434678.a0000 0004 0455 430Xbluebird bio, Cambridge, MA USA
| | - S. Jagannath
- grid.59734.3c0000 0001 0670 2351Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1185, New York, NY 10029 USA
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Alazmah A, Parekh S, Bhatia S, Ashley P. Developing a child patient satisfaction survey: a quality improvement project. Eur Arch Paediatr Dent 2020; 22:209-217. [PMID: 32975808 DOI: 10.1007/s40368-020-00567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
AIM To develop a child-centred patient satisfaction questionnaire for use in an Outpatient Paediatric Dental Department. METHOD Data from patient satisfaction interviews was used to develop a child satisfaction questionnaire, which was used in two different centres after piloting. RESULTS The final questionnaire contained 7 questions and a comments section, using writing and facial images used to record children views. The questionnaire was distributed to 203 children; 95% were happy or okay with the waiting area, 69% were happy about seeing the dentist and 77% children were happy overall. CONCLUSION Measures of satisfaction of children with regard to dental treatment were very different from those commonly used for adults. Further development and implementation of child satisfaction surveys should be considered.
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Affiliation(s)
- A Alazmah
- Department of Preventive Dental Science, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia. .,Department of Paediatric Dentistry, Eastman Dental Hospital, University College London, London, UK.
| | - S Parekh
- Department of Paediatric Dentistry, Eastman Dental Hospital, University College London, London, UK
| | - S Bhatia
- University Dental Hospital, School of Dentistry, Cardiff University, Cardiff, UK
| | - P Ashley
- Department of Paediatric Dentistry, Eastman Dental Hospital, University College London, London, UK
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12
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Monteiro J, Ashley PF, Parekh S. Vital bleaching for children with dental anomalies: EAPD members' survey. Eur Arch Paediatr Dent 2019; 21:565-571. [PMID: 31784871 PMCID: PMC7518994 DOI: 10.1007/s40368-019-00494-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/10/2019] [Accepted: 11/14/2019] [Indexed: 01/09/2023]
Abstract
AIM Understand EAPD members' practices of vital bleaching for children with dental anomalies. METHODS An anonymous online survey sent via EAPD in January 2019, consisting of 13 questions with possible multiple answers and free text. RESULTS 110 responses from 24 countries were obtained. The majority worked in hospitals/universities (n = 69, 63%) or private practices (n = 50, 46%) and were specialists (n = 62, 57%) or senior academics (n = 35, 32%). Most respondents (n = 74 68%) did not provide vital bleaching for children. 88 respondents (80%) belonged to EU: of these, 46 (52%) were not aware of bleaching regulations. For respondents who provided bleaching 26 (72%) undertook home bleaching, using 10% carbamide peroxide (n = 21, 58%), most commonly for 2 weeks (n = 14, 39%), following establishment of the permanent dentition (n = 21, 58%). Deciding factors included: extent (n = 27, 75%) and shade (n = 26, 72%) of discolouration and child being teased by peers (n = 23, 64%). Main reasons for not bleaching included: concerns with side effects (n = 41; 55%) and not agreeing with bleaching (n = 23, 31%). Dentists who did not bleach managed a range of conditions, most frequently molar-incisor hypomineralisation (n = 57; 77%). The majority provided composite restorations with removal of tooth structure (n = 50; 68%) with a number opting for no treatment (n = 27, 37%). CONCLUSION This study shows wide variations in treatment of children's dental anomalies across Europe. Fears of adverse effects and personal beliefs seemed to be the main deterrents to bleaching in children. Clinicians who provided bleaching tended to opt for more conservative techniques and to take children's concerns into consideration.
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Affiliation(s)
| | | | - S Parekh
- Eastman Dental Institute, London, UK
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13
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Saran D, Shankar V, Parekh S, Gedam S, Haritha C, Bhaskar P, Bhange A, Basu T, Saxena U, Samy K, Lohith G. CT Cisternography for Target Delineation in Post MVD Failed Complex Anatomy Trigeminal Neuralgia. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gawde S, Shankar V, Haritha C, Parekh S, Bhaskar V, Karuppusamy A, Bhange A, Kumar BA. Metabolic Regression Velocity Post Lung SBRT - How Early Do We Get to See! Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.290] [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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Ahmad AJ, Parekh S, Ashley PF. Methods of space maintenance for premature loss of a primary molar: a review. Eur Arch Paediatr Dent 2018; 19:311-320. [PMID: 30187262 PMCID: PMC6208772 DOI: 10.1007/s40368-018-0357-5] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 05/16/2018] [Indexed: 01/19/2024]
Abstract
Aim This critical appraisal attempts to answer the question: What is the best method of space maintenance (SM) following premature loss of a primary molar in children under 12 years old? Methods A search to identify studies relevant to the PICO was conducted. Single case reports and studies prior to 1986 were excluded. The principles of GRADE were followed to appraise the evidence. Results 20 studies were identified, which evaluated 2265 space maintainers (SMs). Two studies were graded high quality, four moderate, eight low, and six very low. All studies reported on longevity outcomes and most on adverse effects. Conclusions There was no strong evidence favouring a particular SM, the following recommendations were made: (a) strong recommendations: In cases where rubber dam cannot be used clinicians should not use Glass Fibre Reinforced Composite Resin (GFRCR) SMs. (b) Weak recommendations: Crown and Loop SMs are recommended for loss of primary first molars; GFRCR SMs (placed under rubber dam) are recommended for loss of primary second molars. Bilateral SMs may have questionable efficacy and their use where there is loss of multiple molars in the same quadrant should be weighed against the risk of unwanted tooth movements, loss of a removable SM or no space maintenance at all.
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Affiliation(s)
- A J Ahmad
- Department of Paediatric Dentistry, Eastman Dental Institute, Eastman Dental Hospital, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK.
| | - S Parekh
- Department of Paediatric Dentistry, Eastman Dental Institute, Eastman Dental Hospital, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK
| | - P F Ashley
- Department of Paediatric Dentistry, Eastman Dental Institute, Eastman Dental Hospital, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK
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Laganà A, Perumal D, Melnekoff D, Readhead B, Kidd BA, Leshchenko V, Kuo PY, Keats J, DeRome M, Yesil J, Auclair D, Lonial S, Chari A, Cho HJ, Barlogie B, Jagannath S, Dudley JT, Parekh S. Integrative network analysis identifies novel drivers of pathogenesis and progression in newly diagnosed multiple myeloma. Leukemia 2017. [DOI: 10.1038/leu.2017.197] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Dunleavy K, Roschewski M, Abramson J, Link B, Parekh S, Jagadeesh D, Bierman P, Watson P, Peace D, Hanna W, Powell B, Melani C, Lucas A, Steinberg S, Kahl B, Friedberg J, Little R, Bartlett N, Fanale M, Noy A, Wilson W. RISK-ADAPTED THERAPY IN ADULTS WITH BURKITT LYMPHOMA: UPDATED RESULTS OF a MULTICENTER PROSPECTIVE PHASE II STUDY OF DA-EPOCH-R. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K. Dunleavy
- Center for Cancer Research; National Cancer Institute; Bethesda USA
| | - M. Roschewski
- Center for Cancer Research; National Cancer Institute; Bethesda USA
| | - J.S. Abramson
- Center for Lymphoma; Massachusetts General Hospital; Boston USA
| | - B. Link
- Hematology-Oncology; University of Iowa Hospitals; Iowa City USA
| | - S. Parekh
- Hematology-Oncology; Icahn School of Medicine at Mount Sinai; New Yorki USA
| | - D. Jagadeesh
- Hematology-Oncology; Cleveland Clinic; Cleveland USA
| | - P. Bierman
- Hematology-Oncology; University of Nebraska Medical Center; Omaha USA
| | - P.R. Watson
- Hematology-Oncology; Kinston Medical Specialists; Kinston USA
| | - D. Peace
- Hematology-Oncology; University of Illinois; Chicago USA
| | - W. Hanna
- Hematology-Oncology; University of Tennessee Medical Center; Knoxville USA
| | - B. Powell
- Hematology-Oncology; Comprehensive Cancer Center of Wake Forest University; Winston-Salem USA
| | - C. Melani
- Center for Cancer Research; National Cancer Institute; Bethesda USA
| | - A. Lucas
- Center for Cancer Research; National Cancer Institute; Bethesda USA
| | - S.M. Steinberg
- Center for Cancer Research; National Cancer Institute; Bethesda USA
| | - B. Kahl
- Hematology-Oncology; Washington University; St. Louis USA
| | - J.W. Friedberg
- Hematology-Oncology; University of Rochester; Rochester USA
| | - R.F. Little
- Cancer Therapy Evaluation Program; National Cancer Institute; Rockville USA
| | - N.L. Bartlett
- Hematology-Oncology; Washington University; St. Louis USA
| | - M.A. Fanale
- Hematology-Oncology; MD Anderson Cancer Center; Houston USA
| | - A. Noy
- Hematology-Oncology; Memorial Sloan Kettering Cancer Center; New York USA
| | - W.H. Wilson
- Center for Cancer Research; National Cancer Institute; Bethesda USA
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Khan N, Parekh S, Perumal D, Jegede O, Kahl B. LONG-TERM FOLLOW-UP UPDATE FOR PATIENTS ENROLLED IN ECOG 1405. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_65] [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: 11/10/2022]
Affiliation(s)
- N. Khan
- Medical Oncology; Fox Chase Cancer Center; Philadelphia USA
| | - S. Parekh
- Medical Oncology; The Mount Sinai Hospital; New York USA
| | - D. Perumal
- Medical Oncology; The Mount Sinai Hospital; New York USA
| | - O. Jegede
- Biostatistics; Dana-Farber Cancer Institute; Boston USA
| | - B.S. Kahl
- Medical Oncology; Washington U. School of Medicine; St. Louis USA
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Pillai AA, Maheshwari R, Vora R, Norvell JP, Ford R, Parekh S, Cheng N, Patel A, Young N, Spivey JR, Mgbemena O, Wedd JP. Treatment of HCV infection in liver transplant recipients with ledipasvir and sofosbuvir without ribavirin. Aliment Pharmacol Ther 2017; 45:1427-1432. [PMID: 28382751 DOI: 10.1111/apt.14059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/18/2016] [Accepted: 03/05/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ledipasvir and sofosbuvir is a well-tolerated regimen with high sustained virological response (SVR) rates in pre-liver transplant patients infected with chronic hepatitis C virus (HCV), but data in liver transplant recipients outside of clinical trials is limited. AIM To address this knowledge gap and assess SVR rates without the use of ribavirin in liver transplant recipients METHODS: This is a retrospective study examining the treatment of 75 post-liver transplant recipients with ledipasvir and sofosbuvir without ribavirin. Differences between SVR cohorts and predictors of SVR were analysed in an intention-to-treat (ITT) fashion. RESULTS A total of 408 genotype 1, HCV patients were treated with ledipasvir/sofosbuvir from October 2014 to August 2015 at our centre. Seventy-three patients were post-liver transplant and were treated with a median of 2.9 years from transplant. Ledipasvir/sofosbuvir achieved an SVR12 of 95.9%. African Americans made up 28.8% of the cohort. Sixty-three per cent of patients were treated previously, including 13.7% of patients previously treated with direct-acting antivirals. Only 2.7% had recurrent allograft cirrhosis, and the majority (90.4%) was on calcineurin inhibitor based immunosuppressive therapy. Approximately 82% of patients had chronic kidney disease (CKD) stage 2 or 3. In univariate logistic regression, only detectable week 8 viral load was predictive of failure to achieve SVR. CONCLUSION Our data confirm excellent SVR outcomes and favourable safety and tolerability profiles with ledipasvir/sofosbuvir without ribavirin in post-liver transplant recipients infected with HCV, despite treatment guidelines to use ribavirin.
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Affiliation(s)
| | | | - R Vora
- Emory University, Atlanta, GA, USA
| | | | - R Ford
- Emory University, Atlanta, GA, USA
| | - S Parekh
- Emory University, Atlanta, GA, USA
| | - N Cheng
- Emory University, Atlanta, GA, USA
| | - A Patel
- Emory University, Atlanta, GA, USA
| | - N Young
- Emory University, Atlanta, GA, USA
| | | | | | - J P Wedd
- Emory University, Atlanta, GA, USA
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McCullough AR, Parekh S, Rathbone J, Del Mar CB, Hoffmann TC. A systematic review of the public's knowledge and beliefs about antibiotic resistance–authors' response. J Antimicrob Chemother 2016; 71:2366. [DOI: 10.1093/jac/dkw163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Ratziu V, Harrison SA, Francque S, Bedossa P, Lehert P, Serfaty L, Romero-Gomez M, Boursier J, Abdelmalek M, Caldwell S, Drenth J, Anstee QM, Hum D, Hanf R, Roudot A, Megnien S, Staels B, Sanyal A, Gournay J, Nguyen-Khac E, De Ledinghen V, Larrey D, Tran A, Bourliere M, Maynard-Muet M, Asselah T, Henrion J, Nevens F, Cassiman D, Geerts A, Moreno C, Beuers U, Galle P, Spengler U, Bugianesi E, Craxi A, Angelico M, Fargion S, Voiculescu M, Gheorghe L, Preotescu L, Caballeria J, Andrade R, Crespo J, Callera J, Ala A, Aithal G, Abouda G, Luketic V, Huang M, Gordon S, Pockros P, Poordad F, Shores N, Moehlen M, Bambha K, Clark V, Satapathy S, Parekh S, Reddy R, Sheikh M, Szabo G, Vierling J, Foster T, Umpierrez G, Chang C, Box T, Gallegos-Orozco J. Elafibranor, an Agonist of the Peroxisome Proliferator-Activated Receptor-α and -δ, Induces Resolution of Nonalcoholic Steatohepatitis Without Fibrosis Worsening. Gastroenterology 2016; 150:1147-1159.e5. [PMID: 26874076 DOI: 10.1053/j.gastro.2016.01.038] [Citation(s) in RCA: 719] [Impact Index Per Article: 89.9] [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: 10/19/2015] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Elafibranor is an agonist of the peroxisome proliferator-activated receptor-α and peroxisome proliferator-activated receptor-δ. Elafibranor improves insulin sensitivity, glucose homeostasis, and lipid metabolism and reduces inflammation. We assessed the safety and efficacy of elafibranor in an international, randomized, double-blind placebo-controlled trial of patients with nonalcoholic steatohepatitis (NASH). METHODS Patients with NASH without cirrhosis were randomly assigned to groups given elafibranor 80 mg (n = 93), elafibranor 120 mg (n = 91), or placebo (n = 92) each day for 52 weeks at sites in Europe and the United States. Clinical and laboratory evaluations were performed every 2 months during this 1-year period. Liver biopsies were then collected and patients were assessed 3 months later. The primary outcome was resolution of NASH without fibrosis worsening, using protocol-defined and modified definitions. Data from the groups given the different doses of elafibranor were compared with those from the placebo group using step-down logistic regression, adjusting for baseline nonalcoholic fatty liver disease activity score. RESULTS In intention-to-treat analysis, there was no significant difference between the elafibranor and placebo groups in the protocol-defined primary outcome. However, NASH resolved without fibrosis worsening in a higher proportion of patients in the 120-mg elafibranor group vs the placebo group (19% vs 12%; odds ratio = 2.31; 95% confidence interval: 1.02-5.24; P = .045), based on a post-hoc analysis for the modified definition. In post-hoc analyses of patients with nonalcoholic fatty liver disease activity score ≥4 (n = 234), elafibranor 120 mg resolved NASH in larger proportions of patients than placebo based on the protocol definition (20% vs 11%; odds ratio = 3.16; 95% confidence interval: 1.22-8.13; P = .018) and the modified definitions (19% vs 9%; odds ratio = 3.52; 95% confidence interval: 1.32-9.40; P = .013). Patients with NASH resolution after receiving elafibranor 120 mg had reduced liver fibrosis stages compared with those without NASH resolution (mean reduction of 0.65 ± 0.61 in responders for the primary outcome vs an increase of 0.10 ± 0.98 in nonresponders; P < .001). Liver enzymes, lipids, glucose profiles, and markers of systemic inflammation were significantly reduced in the elafibranor 120-mg group vs the placebo group. Elafibranor was well tolerated and did not cause weight gain or cardiac events, but did produce a mild, reversible increase in serum creatinine (effect size vs placebo: increase of 4.31 ± 1.19 μmol/L; P < .001). CONCLUSIONS A post-hoc analysis of data from trial of patients with NASH showed that elafibranor (120 mg/d for 1 year) resolved NASH without fibrosis worsening, based on a modified definition, in the intention-to-treat analysis and in patients with moderate or severe NASH. However, the predefined end point was not met in the intention to treat population. Elafibranor was well tolerated and improved patients' cardiometabolic risk profile. ClinicalTrials.gov number: NCT01694849.
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Affiliation(s)
- Vlad Ratziu
- Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France; Institute of Cardiometabolism and Nutrition, INSERM, UMRS 938, Paris, France.
| | - Stephen A Harrison
- Department of Medicine, Gastroenterology and Hepatology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Sven Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Pierre Bedossa
- Department of Pathology, Hôpital Beaujon, University Paris-Denis Diderot, Paris, France
| | - Philippe Lehert
- Department of Psychiatry, the University of Melbourne, Melbourne, Australia; Faculty of Economics, University of Louvain UCL, Belgique, Belgium
| | - Lawrence Serfaty
- Université Pierre et Marie Curie, Hôpital Saint-Antoine, Paris, France
| | - Manuel Romero-Gomez
- Unit for the Clinical Management of Digestive Diseases and CIBERehd, Hospital Universitario de Valme, Sevilla
| | - Jérôme Boursier
- Hepatology Department, University Hospital and LUNAM University, Angers, France
| | | | - Steve Caldwell
- Gastroenterology and Hepatology Division, University of Virginia, Charlottesville, Virginia
| | - Joost Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Quentin M Anstee
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | | | - Bart Staels
- University of Lille, INSERM UMR1011, Institut Pasteur de Lille, European Genomic Institute for Diabetes, Lille, France
| | - Arun Sanyal
- Virginia Commonwealth University, Richmond, Virginia
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Ratner L, Rauch D, Abel H, Caruso B, Noy A, Barta SK, Parekh S, Ramos JC, Ambinder R, Phillips A, Harding J, Baydoun HH, Cheng X, Jacobson S. Dose-adjusted EPOCH chemotherapy with bortezomib and raltegravir for human T-cell leukemia virus-associated adult T-cell leukemia lymphoma. Blood Cancer J 2016; 6:e408. [PMID: 27015285 PMCID: PMC4817103 DOI: 10.1038/bcj.2016.21] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- L Ratner
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - D Rauch
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - H Abel
- Department of Genetics, Washington University School of Medicine, St Louis, MO, USA
| | - B Caruso
- Viral Immunology Section, Neuroimmunology and Neurovirology Division, NINDS, NIH, Bethesda, MD, USA
| | - A Noy
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S K Barta
- Division of Hematology-Oncology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - S Parekh
- Division of Hematology-Oncology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - J C Ramos
- Division of Hematology-Oncology, Department of Medicine, University of Miami School of Medicine, Miami, FL, USA
| | - R Ambinder
- Division of Hematologic Malignancies, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Phillips
- Division of Hematology-Oncology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - J Harding
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - H H Baydoun
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - X Cheng
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - S Jacobson
- Viral Immunology Section, Neuroimmunology and Neurovirology Division, NINDS, NIH, Bethesda, MD, USA
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McCullough AR, Parekh S, Rathbone J, Del Mar CB, Hoffmann TC. A systematic review of the public's knowledge and beliefs about antibiotic resistance. J Antimicrob Chemother 2015; 71:27-33. [PMID: 26459555 DOI: 10.1093/jac/dkv310] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/29/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this study was to systematically review quantitative and qualitative studies on the public's knowledge and beliefs about antibiotic resistance. METHODS We searched four databases to July 2014, with no language or study design restrictions. Two reviewers independently extracted data. We calculated the median (IQR) of the proportion of participants who agreed with each statement and synthesized qualitative data by identifying emergent themes. RESULTS Of 3537 articles screened, 54 studies (41 quantitative, 3 mixed methods and 10 qualitative) were included (55 225 participants). Most studied adults (50; 93% studies) and were conducted in Europe (23; 43%), Asia (14; 26%) or North America (12; 22%). Some participants [median 70% (IQR 50%-84%); n = 8 studies] had heard of antibiotic resistance, but most [median 88% (IQR 86%-89%); n = 2 studies] believed it referred to changes in the human body. Many believed excessive antibiotic use [median 70% (IQR 59%-77%); n = 11 studies] and not completing antibiotic courses [median 62% (IQR 47%-77%); n = 8 studies] caused resistance. Most participants nominated reducing antibiotic use [median 74% (IQR 72%-85%); n = 4 studies] and discussing antibiotic resistance with their clinician (84%, n = 1 study) as strategies to reduce resistance. Qualitative data supported these findings and additionally identified that: participants believed they were at low risk from antibiotic resistance participants; largely attributed its development to the actions of others; and strategies to minimize resistance should be primarily aimed at clinicians. CONCLUSIONS The public have an incomplete understanding of antibiotic resistance and misperceptions about it and its causes and do not believe they contribute to its development. These data can be used to inform interventions to change the public's beliefs about how they can contribute to tackling this global issue.
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Affiliation(s)
- A R McCullough
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia
| | - S Parekh
- School of Public Health, University of Queensland, Herston, Australia Centre of National Research on Disability and Rehabilitation Medicine, Griffith Health Institute, Griffith University, Queensland 4131, Australia
| | - J Rathbone
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia
| | - C B Del Mar
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia
| | - T C Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia
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McCullough AR, Rathbone J, Parekh S, Hoffmann TC, Del Mar CB. Not in my backyard: a systematic review of clinicians' knowledge and beliefs about antibiotic resistance. J Antimicrob Chemother 2015; 70:2465-73. [PMID: 26093375 DOI: 10.1093/jac/dkv164] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/24/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To systematically review clinicians' knowledge and beliefs about the importance and causes of antibiotic resistance, and strategies to reduce resistance. METHODS Four databases were searched (until July 2014), without restrictions on language, setting or study design. Fixed responses (from surveys) were grouped into categories. The proportion of participants who agreed with each category was expressed as median, percentage and IQR. Qualitative data were coded into emergent themes. Quantitative categories and qualitative themes were grouped into four overarching categories that emerged from the data. RESULTS There were 57 included studies (38 quantitative, 14 qualitative, 5 mixed methods) of 11593 clinicians. Most clinicians (69%, IQR 63%-72%, n=5 studies) had heard of antibiotic resistance and 98% (IQR 93%-99%, n=5 studies) believed it was serious. The proportion who believed it was a problem for their practice (67%, IQR 65%-74%, n=13 studies) was smaller than the proportion who believed it was a problem globally (89%, IQR 85%-97%, n=5 studies) or nationally (92%, IQR 88%-95%, n=21 studies). Most believed excessive antibiotic use (97%, IQR 91%-98%, n=12 studies) and patient non-adherence (90%, IQR 82%-92%, n=7 studies) caused resistance. Most knew of strategies to reduce resistance (e.g. clinician education, 90%, IQR 85%-96%, n=7 studies). Qualitative findings support these data: they attributed responsibility for antibiotic resistance to patients, other countries and healthcare settings; resistance was considered a low priority and a distant consequence of antibiotic prescribing. CONCLUSIONS Clinicians believe antibiotic resistance is a serious problem, but think it is caused by others. This needs to be accommodated in interventions to reduce antibiotic resistance.
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Affiliation(s)
- A R McCullough
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia
| | - J Rathbone
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia
| | - S Parekh
- Centre of National Research on Disability and Rehabilitation Medicine, Griffith Health Institute, Griffith University, Queensland 4131, Australia
| | - T C Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia
| | - C B Del Mar
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland 4229, Australia
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Parekh S, Bodicoat DH, Brady E, Webb D, Mani H, Mostafa S, Levy MJ, Khunti K, Davies MJ. Clinical characteristics of people experiencing biochemical hypoglycaemia during an oral glucose tolerance test: cross-sectional analyses from a UK multi-ethnic population. Diabetes Res Clin Pract 2014; 104:427-34. [PMID: 24685116 DOI: 10.1016/j.diabres.2014.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 10/11/2013] [Revised: 01/21/2014] [Accepted: 02/19/2014] [Indexed: 01/21/2023]
Abstract
AIMS People who experience biochemical hypoglycaemia during an oral glucose tolerance test (OGTT) may be insulin resistant, but this has not been investigated robustly, therefore we examined this in a population-based multi-ethnic UK study. METHODS Cross-sectional data from 6478 diabetes-free participants (849 with fasting insulin data available) who had an OGTT in the ADDITION-Leicester screening study (2005-2009) were analysed. People with biochemical hypoglycaemia (2-h glucose <3.3mmol/l) were compared with people with normal glucose tolerance (NGT) or impaired glucose regulation (IGR) using regression methods. RESULTS 359 participants (5.5%) had biochemical hypoglycaemia, 1079 (16.7%) IGR and 5040 (77.8%) NGT. Biochemical hypoglycaemia was associated with younger age (P<0.01), white European ethnicity (P<0.001), higher HDL cholesterol (P<0.01), higher insulin sensitivity (P<0.05), and lower body mass index (P<0.001), blood pressure (P<0.01), fasting glucose (P<0.001), HbA1C (P<0.01), and triglycerides (P<0.01) compared with NGT and IGR separately in both unadjusted and adjusted (age, sex, ethnicity, body mass index, smoking status) models. CONCLUSIONS Biochemical hypoglycaemia during an OGTT in the absence of diabetes or IGR was not associated with insulin resistance, but instead appeared to be associated with more favourable glycaemic risk profiles than IGR and NGT. Thus, clinicians may not need to intervene due to biochemical hypoglycaemia on a 2-h OGTT.
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Affiliation(s)
- S Parekh
- University of Leicester, Diabetes Research Centre, UK
| | - D H Bodicoat
- University of Leicester, Diabetes Research Centre, UK; University of Leicester, Leicester Clinical Trials Unit, UK.
| | - E Brady
- University of Leicester, Leicester Clinical Trials Unit, UK; Department of Diabetes Research, University Hospitals of Leicester, NHS Trust, UK
| | - D Webb
- University of Leicester, Diabetes Research Centre, UK; University of Leicester, Leicester Clinical Trials Unit, UK
| | - H Mani
- University of Leicester, Diabetes Research Centre, UK; Department of Diabetes and Endocrinology, University Hospitals of Leicester, NHS Trust, UK
| | - S Mostafa
- University of Leicester, Diabetes Research Centre, UK
| | - M J Levy
- Department of Diabetes Research, University Hospitals of Leicester, NHS Trust, UK
| | - K Khunti
- University of Leicester, Diabetes Research Centre, UK; University of Leicester, Leicester Clinical Trials Unit, UK
| | - M J Davies
- University of Leicester, Diabetes Research Centre, UK; University of Leicester, Leicester Clinical Trials Unit, UK
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Kuo PY, Leshchenko VV, Fazzari MJ, Perumal D, Gellen T, He T, Iqbal J, Baumgartner-Wennerholm S, Nygren L, Zhang F, Zhang W, Suh KS, Goy A, Yang DT, Chan WC, Kahl BS, Verma AK, Gascoyne RD, Kimby E, Sander B, Ye BH, Melnick AM, Parekh S. High-resolution chromatin immunoprecipitation (ChIP) sequencing reveals novel binding targets and prognostic role for SOX11 in mantle cell lymphoma. Oncogene 2014; 34:1231-40. [PMID: 24681958 DOI: 10.1038/onc.2014.44] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 01/07/2014] [Accepted: 01/19/2014] [Indexed: 12/18/2022]
Abstract
Sex determining region Y-box 11 (SOX11) expression is specific for mantle cell lymphoma (MCL) as compared with other non-Hodgkin's lymphomas. However, the function and direct-binding targets of SOX11 in MCL are largely unknown. We used high-resolution chromatin immunoprecipitation sequencing to identify the direct target genes of SOX11 in a genome-wide, unbiased manner and elucidate its functional significance. Pathway analysis identified WNT, PKA and TGF-beta signaling pathways as significantly enriched by SOX11-target genes. Quantitative chromatin immunoprecipitation sequencing and promoter reporter assays confirmed that SOX11 directly binds to individual genes and modulates their transcription activities in these pathways in MCL. Functional studies using RNA interference demonstrate that SOX11 directly regulates WNT in MCL. We analyzed SOX11 expression in three independent well-annotated tissue microarrays from the University of Wisconsin (UW), Karolinska Institute and British Columbia Cancer Agency. Our findings suggest that high SOX11 expression is associated with improved survival in a subset of MCL patients, particularly those treated with intensive chemotherapy. Transcriptional regulation of WNT and other biological pathways affected by SOX11-target genes may help explain the impact of SOX11 expression on patient outcomes.
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Affiliation(s)
- P-Y Kuo
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - V V Leshchenko
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M J Fazzari
- 1] Department of Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA [2] Department of Genetics, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - D Perumal
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T Gellen
- Albert Einstein Cancer Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - T He
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Baumgartner-Wennerholm
- Department of Medicine, Center for Haematology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - L Nygren
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - F Zhang
- Bioinformatics Laboratory, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - W Zhang
- Bioinformatics Laboratory, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K S Suh
- Genomics and Biomarkers Program, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - A Goy
- Genomics and Biomarkers Program, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - D T Yang
- Department of Pathology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - W-C Chan
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - B S Kahl
- Department of Medicine, School of Medicine and Public Health, and The UW Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - A K Verma
- Albert Einstein Cancer Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - R D Gascoyne
- Department of Pathology and Experimental Therapeutics, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - E Kimby
- Department of Medicine, Center for Haematology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - B Sander
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - B H Ye
- Department of Cell Biology, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
| | - A M Melnick
- 1] Hematology and Oncology Division, Weill Cornell Medical College, New York, NY, USA [2] Department of Pharmacology, Weill Cornell Medical College, New York, NY, USA
| | - S Parekh
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Xing M, Sakaria S, Dhanasekaran R, Kokabi N, Camacho J, Parekh S, Spivey J, Kim H. Bridging locoregional therapy enhances long-term survivals in hepatocellular carcinoma patients listed for liver transplant within the milan criteria: a 15-year experience. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.390] [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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Xing M, Dhanasekaran R, Kokabi N, Camacho J, Parekh S, Knechtle S, Adsay V, Spivey J, Kim H. Clinicopathologic factors predicting hepatocellular carcinoma recurrence in patients receiving bridging locoregional therapy for orthotopic liver transplantation: a 15-year experience. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Mustafa O, Parekh S, Ashley P, Anand P. Post-operative pain and anxiety related to dental procedures in children. Eur J Paediatr Dent 2013; 14:289-294. [PMID: 24313580] [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: 06/02/2023]
Abstract
AIM To determine post-operative pain in children following treatment in the dental chair and its relation to dental anxiety. METHODS A group of 125 children, aged 5 to 18 years, attending for dental treatment had their pain recorded post-operatively using the revised version of the Faces Pain Scale (FPS-R) and the Visual Analogue Scale (VAS). Baseline anxiety scores were also recorded using the Modified Child Dental Anxiety Scale (faces) (MCDASf). RESULTS The mean MCDASf score was 20.1. Post-operative pain was reported in 62% of children at 2 hours, 51% at 4, and 47% at 6 hours. The surgical subgroup reported the most pain (79%), whereas the conservative treatment for primary teeth group reported the least pain (37%). Anxious patients (MCDASf > = 17) were more likely to report pain than less anxious patients at 2 (p=0.02) and 6 (p=0.03) hours post-operatively. CONCLUSION Dental procedures are associated with post-operative pain in children. Anxious patients are more likely to report pain.
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Affiliation(s)
- O Mustafa
- Consultant in Paediatric Dentistry, Dental and Maxillofacial Centre, Bahrain Defence Force
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Schindler J, Gajavelli S, Ravandi F, Shen Y, Parekh S, Braunchweig I, Barta S, Ghetie V, Vitetta E, Verma A. A phase I study of a combination of anti-CD19 and anti-CD22 immunotoxins (Combotox) in adult patients with refractory B-lineage acute lymphoblastic leukaemia. Br J Haematol 2011; 154:471-6. [PMID: 21732928 PMCID: PMC3877839 DOI: 10.1111/j.1365-2141.2011.08762.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Novel agents are needed for patients with refractory and relapsed acute lymphoblastic leukaemia (ALL). Combotox is a 1:1 mixture of two immunotoxins (ITs), prepared by coupling deglycosylated ricin A chain (dgRTA) to monoclonal antibodies directed against CD22 (RFB4-dgRTA) and CD19 (HD37-dgRTA). Pre-clinical data demonstrated that Combotox was effective in killing both pre-B-ALL cell lines and cells from patients with pre-B ALL. A clinical study of paediatric patients in which 3 of 17 patients with ALL experienced complete remission, supported the preclinical work and motivated this study. This study was a Phase I, dose-escalation trial using Combotox in adults with refractory or relapsed B-lineage-ALL. A cycle consisted of three doses, with one dose given every other day. Dose levels were 3, 5, 6, 7 and 8 mg/m(2) per dose. Seventeen patients, aged 19-72 years, were enrolled in this multi-institution study. The maximum tolerated dose was 7 mg/m(2) /dose (21 mg/m(2) /cycle) and vascular leak syndrome was the dose-limiting toxicity. Two patients developed reversible grade 3 elevations in liver function tests. One patient achieved partial remission and proceeded to allogeneic stem cell transplantation. All patients with peripheral blasts experienced decreased blast counts following the administration of Combotox. Thus, Combotox can be safely administered to adults with refractory leukaemia.
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Affiliation(s)
- J. Schindler
- Cancer Immunobiology Center, University of Texas, Southwestern Medical Center, Dallas, TX
| | | | | | - Y. Shen
- Cancer Immunobiology Center, University of Texas, Southwestern Medical Center, Dallas, TX
| | - S. Parekh
- Albert Einstein College of Medicine, Bronx, NY
| | | | - S Barta
- Albert Einstein College of Medicine, Bronx, NY
| | - V. Ghetie
- Cancer Immunobiology Center, University of Texas, Southwestern Medical Center, Dallas, TX
| | - E. Vitetta
- Cancer Immunobiology Center, University of Texas, Southwestern Medical Center, Dallas, TX
| | - A. Verma
- Albert Einstein College of Medicine, Bronx, NY
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Dhanasekaran R, Subramanian R, Parekh S, Spivey J, Martin L, Kim H. Abstract No. 323: Transjugular intrahepatic portosystemic shunt (TIPS): Time trends in etiology of cirrhosis, indications, and survival. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.355] [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: 10/18/2022] Open
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Ashley PF, Parry J, Parekh S, Al-Chihabi M, Ryan D. Sedation for dental treatment of children in the primary care sector (UK). Br Dent J 2010; 208:E21; discussion 522-3. [PMID: 20543774 DOI: 10.1038/sj.bdj.2010.542] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Accepted: 04/24/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To audit the clinical practice of a dental sedation service in the primary care sector and determine which services dentists use to manage unco-operative children. DESIGN Retrospective analysis and prospective audit. SETTING Sedation clinic in primary care, 2007, England. SUBJECTS Children attending for dental treatment under sedation. General dental practitioners (GDPs) in the Brighton and West Sussex regions. INTERVENTIONS Questionnaire. MAIN OUTCOME MEASURES Clinical service audit, patient satisfaction, referrer satisfaction. RESULTS Four hundred children (age range 5-12 years) had been referred for caries (78%), with the remainder for orthodontic extractions. The most common treatment carried out on primary and permanent teeth was extractions followed by restorations. A combination of intravenous (IV) midazolam/ketamine/fentanyl was used in 40% of cases, and IV midazolam/ketamine was used in 34% of cases. Seventy-four percent of parents responded to the satisfaction questionnaire; of these 97% rated sedation as excellent/good and 80% would choose sedation or recommend sedation for others. Only 45% of questionnaires to referrers were returned. Fifty-six percent of dentists preferred general anaesthesia (GA) and 66% preferred IV sedation. CONCLUSIONS Dental treatment for children was provided under IV sedation with most parents satisfied with the procedure. Little difference was seen between referring dentists' perceptions of IV sedation or GA.
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Affiliation(s)
- P F Ashley
- Department of Paediatric Dentistry, UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD.
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Song F, Parekh S, Hooper L, Loke YK, Ryder J, Sutton AJ, Hing C, Kwok CS, Pang C, Harvey I. Dissemination and publication of research findings: an updated review of related biases. Health Technol Assess 2010; 14:iii, ix-xi, 1-193. [PMID: 20181324 DOI: 10.3310/hta14080] [Citation(s) in RCA: 538] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To identify and appraise empirical studies on publication and related biases published since 1998; to assess methods to deal with publication and related biases; and to examine, in a random sample of published systematic reviews, measures taken to prevent, reduce and detect dissemination bias. DATA SOURCES The main literature search, in August 2008, covered the Cochrane Methodology Register Database, MEDLINE, EMBASE, AMED and CINAHL. In May 2009, PubMed, PsycINFO and OpenSIGLE were also searched. Reference lists of retrieved studies were also examined. REVIEW METHODS In Part I, studies were classified as evidence or method studies and data were extracted according to types of dissemination bias or methods for dealing with it. Evidence from empirical studies was summarised narratively. In Part II, 300 systematic reviews were randomly selected from MEDLINE and the methods used to deal with publication and related biases were assessed. RESULTS Studies with significant or positive results were more likely to be published than those with non-significant or negative results, thereby confirming findings from a previous HTA report. There was convincing evidence that outcome reporting bias exists and has an impact on the pooled summary in systematic reviews. Studies with significant results tended to be published earlier than studies with non-significant results, and empirical evidence suggests that published studies tended to report a greater treatment effect than those from the grey literature. Exclusion of non-English-language studies appeared to result in a high risk of bias in some areas of research such as complementary and alternative medicine. In a few cases, publication and related biases had a potentially detrimental impact on patients or resource use. Publication bias can be prevented before a literature review (e.g. by prospective registration of trials), or detected during a literature review (e.g. by locating unpublished studies, funnel plot and related tests, sensitivity analysis modelling), or its impact can be minimised after a literature review (e.g. by confirmatory large-scale trials, updating the systematic review). The interpretation of funnel plot and related statistical tests, often used to assess publication bias, was often too simplistic and likely misleading. More sophisticated modelling methods have not been widely used. Compared with systematic reviews published in 1996, recent reviews of health-care interventions were more likely to locate and include non-English-language studies and grey literature or unpublished studies, and to test for publication bias. CONCLUSIONS Dissemination of research findings is likely to be a biased process, although the actual impact of such bias depends on specific circumstances. The prospective registration of clinical trials and the endorsement of reporting guidelines may reduce research dissemination bias in clinical research. In systematic reviews, measures can be taken to minimise the impact of dissemination bias by systematically searching for and including relevant studies that are difficult to access. Statistical methods can be useful for sensitivity analyses. Further research is needed to develop methods for qualitatively assessing the risk of publication bias in systematic reviews, and to evaluate the effect of prospective registration of studies, open access policy and improved publication guidelines.
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Affiliation(s)
- F Song
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
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Dhanasekaran R, West J, Gonzales P, Subramanian R, Parekh S, Spivey J, Reshamwala P, Martin L, Kim H. Abstract No. 83: Survival after transjugular intrahepatic portosystemic shunts - covered vs. uncovered stents. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.232] [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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Dhanasekaran R, Gonzales P, West J, Subramanian R, Parekh S, Spivey J, Reshamwala P, Martin L, Kim H. Abstract No. 82: Transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.231] [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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Sakaria SS, Dhanasekaran R, Pankonin M, Parekh S, Kauh JS, Kim HS. Locoregional therapies as a bridge to transplant in patients with hepatocellular carcinoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15608] [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: 11/20/2022] Open
Abstract
e15608 Background: Orthotopic liver transplantation (OLT) has been widely established as the definitive treatment for patients with HCC who fit within the Milan criteria. The limited availability of donor organs results in prolonged waiting periods leading to tumor progression and potential disqualification for OLT. As a result, there has been a rising interest in locoregional therapies that may stall tumor progression until a donor organ is available for transplantation. Methods: We reviewed patients with a diagnosis of HCC on the transplant list between 1998 and 2008. Of these patients, 72 patients received locoregional therapies (LRT). The various LRT consisted of transcatheter therapy alone (29 patients); combination transcatheter therapy and radiofrequency ablation (RFA) (33 patients), and RFA alone (10 patients). Kaplan Meier method with the log rank test and Cox proportional hazards method were used for survival analysis. Results: Of the 72 patients, 71% (51/72) were transplanted and 29% (21/72) dropped out. The reasons for drop-out from the transplant list included tumor progression (4.2%); condition deteriorated (11.1%); death (6.9%); refusal of transplant (2.7%); other causes (4.2%). The long term survival rates in the transplanted patients at 1 yr, 2 yrs and 5 yrs is 90%, 87% and 72%. The long term survival in the non-transplanted patients at 1 yr and 2 yrs is 47% and 33% respectively. Mean duration from the first LRT to OLT was 126 days (SD 208). In patients who dropped out, mean duration from the first LRT to the removal date was 143 days (SD 256). The mean post transplant follow-up period was 758 days (SD 527). No recurrence was found in the post transplant follow- up. Conclusions: Locoregional therapies can be effectively used as a bridging therapy to treat patients with HCC awaiting transplant. The long term recurrence-free survival in patients who received OLT after bridging therapies demonstrated 5-year survival rates of 72% and no recurrence after transplant. No significant financial relationships to disclose.
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Affiliation(s)
- S. S. Sakaria
- Emory University, Decatur, GA; Emory University, Atlanta, GA
| | - R. Dhanasekaran
- Emory University, Decatur, GA; Emory University, Atlanta, GA
| | - M. Pankonin
- Emory University, Decatur, GA; Emory University, Atlanta, GA
| | - S. Parekh
- Emory University, Decatur, GA; Emory University, Atlanta, GA
| | - J. S. Kauh
- Emory University, Decatur, GA; Emory University, Atlanta, GA
| | - H. S. Kim
- Emory University, Decatur, GA; Emory University, Atlanta, GA
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Al-Habsi SA, Roberts GJ, Attari N, Parekh S. A survey of attitudes, knowledge and practice of dentists in London towards child protection. Are children receiving dental treatment at the Eastman Dental Hospital likely to be on the child protection register? Br Dent J 2009; 206:E7; discussion 212-3. [PMID: 19214195 DOI: 10.1038/sj.bdj.2009.113] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2008] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the attitudes, knowledge and practices of general dental practitioners (GDPs), specialists and consultants in paediatric dentistry in London, towards child protection. Additionally, to determine if children attending paediatric dental casualty at the Eastman Dental Hospital (EDH) and those who need treatment of caries under general anaesthesia (GA) are on the child protection register (CPR). DESIGN The survey was conducted by postal questionnaires with 14 closed questions. A total of 228 dentists were invited to participate in the study. Children who attended EDH and required treatment under GA or at paediatric dental casualty were checked against the CPR. RESULTS The respond rate was 46% (105/228). Overall 15% (16/105) of dentists had seen at least one patient with suspected child abuse in the last six months, but only 7% (7/105) referred or reported cases to child protection services. Reasons for dentists not referring included: fear of impact on practice (10%; 11/105); fear of violence to child (66%; 69/105); fear of litigation (28%; 29/105); fear of family violence against them (26%; 27/105); fear of consequences to the child (56%; 59/105); lack of knowledge regarding the procedures for referral (68%; 71/105); and lack of certainty about the diagnosis (86%; 90/105). Of the 220 children attending for dental GA and casualty from October 2004 to March 2005, one child was found to be on the CPR. CONCLUSION More information and training is required to raise awareness of the potential importance of the role of dentists in child protection. Improved communication between dental and medical departments is important for safeguarding children.
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Affiliation(s)
- S A Al-Habsi
- Unit of Paediatric Dentistry, UCL Eastman Dental Institute and Hospital, 256 Gray's Inn road, London WC1X 8LD.
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Khanna V, Dhanasekaran R, Spivey J, Parekh S, Knechtle S, Carew J, Kim H. Abstract No. 197: Role of Transcatheter Therapy as a Bridge to Liver Transplant for HCC Patients. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.187] [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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Addo ME, Parekh S, Moles DR, Roberts GJ. Knowledge of dental trauma first aid (DTFA): the example of avulsed incisors in casualty departments and schools in London. Br Dent J 2007; 202:E27. [PMID: 17435696 DOI: 10.1038/bdj.2007.328] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2006] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate awareness and practices of dental trauma first aid (DTFA) in hospital emergency settings and in primary and secondary schools in London. DESIGN A cross-sectional study using self-administered questionnaires and semi-structured interviews. SETTING Primary and secondary schools and casualty/emergency and walk-in casualty centres in London in 2005. SUBJECTS AND METHODS A randomly selected sample of 125 schools and a total of 31 walk-in casualty centres, providing services for five randomly selected London boroughs. A person responsible for emergency care of children represented each of these study sites. RESULTS Response rates of 81.6% and 87% were achieved for schools and casualty/emergency centres respectively. The school respondents who had previously received advice on DTFA were three times more likely to be willing to replant an avulsed tooth compared to those who had not. A third of casualty personnel showed gaps in knowledge in DTFA. Results from schools showed an unwillingness to start emergency action mainly due to perceived inadequacy in knowledge/skills and also for legal reasons. CONCLUSION There is the need for further studies focused on the barriers resulting in unwillingness to provide DTFA among school personnel and clarification regarding issues of responsibility and acceptable levels of competence of professionals other than dentists.
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Affiliation(s)
- M E Addo
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
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Abstract
OBJECTIVES To evaluate the esthetic acceptability range of computer-generated variations in smile arc and buccal corridor. DESIGN Web-based descriptive study using available subjects. SETTING AND SAMPLE POPULATION The World Wide Web. Subjects for the main study included 115 lay and 131 orthodontist raters. EXPERIMENTAL VARIABLES Buccal corridors and smile arcs, each presented for a female and a male image. Buccal corridors were presented as none, ideal and excessive. The smile arc was presented as flat, ideal and excessive. The nine male and female variations, as combinations of the above variables, were each presented twice to evaluate reliability. OUTCOME MEASURE Acceptability of buccal corridors and smile arcs using the web-based instrument. An arbitrary super majority threshold of acceptability was set at 67% approval. RESULTS Both laypersons and orthodontists showed good reliability (k >or= 0.70). There was a broad range of acceptability, but laypersons and orthodontists showed no significant differences on the two variables tested. While orthodontists and laypersons both found smiles with excessive buccal corridors to be significantly less acceptable than those with ideal or absent buccal corridors, they were still acceptable over 70% of the time. Flat smile arcs were only acceptable 50-60% of the time, while smiles with ideal and excessive smile arcs were significantly more acceptable 84-95% of the time. When examining buccal corridors and smile arcs together, excessive buccal corridors were significantly less acceptable than ideal or absent buccal corridors regardless of the smile arc. A flat smile arc significantly reduced the acceptability of any buccal corridor to below the threshold of acceptability. CONCLUSIONS Laypersons and orthodontists have similar preferences when acceptability of buccal corridors and smile arcs are considered. Flat smile arcs are more detrimental to smile esthetics than variations in buccal corridors. Clinicians must realize that although attractiveness may be reduced by variations in buccal corridors and smile arcs, the result may still be acceptable to a majority of people.
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Affiliation(s)
- S Parekh
- Private Practitioner, Dayton, OH, USA
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Abstract
In patients infected with human immunodeficiency virus (HIV), zidovudine has been known to cause a severe hypoproliferative anemia that resolves promptly when the drug is stopped. Some patients, however, may come to medical attention after having stopped taking the drug for 1-2 weeks and may already be in the recovery phase and present with severe anemia, normoblastemia, and reticulocytosis. These features can be mistaken for hemolytic disease, as shown by our experience with three such patients.
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Affiliation(s)
- P R Koduri
- Department of Medicine, Cook County Hospital, Hektoen Building, Room 817, Chicago, IL 60612, USA
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Affiliation(s)
- S Parekh
- Department of Medicine, Cook County Hospital and Rush Medical College, 1900 W Polk #650, Chicago, IL 60612, USA
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Cogswell LP, Raines DE, Parekh S, Jonas O, Maggio JE, Strichartz GR. Development of a novel probe for measuring drug binding to the F1*S variant of human alpha 1-acid glycoprotein. J Pharm Sci 2001; 90:1407-23. [PMID: 11745793 DOI: 10.1002/jps.1093] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A novel probe was developed to measure drug association with the F1*S variant of the human serum protein alpha 1-acid glycoprotein (AGP). The molecule 2-hydroxy-3,5-diiodo-N-[2(diethylamino)ethyl]benzamide (DEDIC) binds to AGP, quenching its native fluorescence. This quenching was fitted to a two-site model giving apparent dissociation constants of 0.049 +/- 0.005 and 12 +/- 2 microM (mean +/- SEM). Quenching of each of the separate variants of AGP by DEDIC was itself described by a two-site model, giving for the F1*S variant K(D)(1)((F1*S)) = 0.041 +/- 0.010 microM and K(D)(2)((F1*S)) = 29 +/- 7 microM; and for the A variant K(D)(1)((A)) = 0.31 +/- 0.18 microM and K(D)(2)((A)) = 8.8 +/- 0.7 microM. The utility of DEDIC in probing drug interactions with isolated variants was demonstrated in competition experiments with the model drugs amitriptyline and bupivacaine. In addition, the selectivity of DEDIC for variant F1*S rendered it capable of probing the binding of drugs (including the variant A-selective drug amitriptyline) to F1*S in a mixture of variants, such as occurs naturally in whole AGP. DEDIC is unique as an F1*S variant-selective probe of drug binding to whole AGP that is also sufficiently soluble to serve as a probe of drug binding to the lower affinity sites on isolated A and F1*S variants.
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Affiliation(s)
- L P Cogswell
- Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Abstract
A family with combined deficiency of factor VIII and factor IX is reported. Family study showed that the father and his nephew had mild factor VIII deficiency with normal von Willebrand factor antigen and factor IX levels while his two sons had a reduced level of factor IX and normal factor VIII levels. His wife was found to have marginally reduced factor IX levels, whereas his daughter had reduced or normal levels of both factors VIII and IX. DNA analysis using the intra- and extragenic markers of factor VIII and IX genes showed that mother is a carrier of haemophilia B and the daughter is a carrier for both haemophilia A and B. Thus, the combined deficiency observed was due to a chance association of two distinct genetic defects.
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Affiliation(s)
- S Shetty
- Institute of Immunohematology (ICMR), KEM Hospital, Parel, Mumbai, India
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Abstract
Improvement of microbial strains for the overproduction of industrial products has been the hallmark of all commercial fermentation processes. Conventionally, strain improvement has been achieved through mutation, selection, or genetic recombination. Overproduction of primary or secondary metabolites is a complex process, and successful development of improved strains requires a knowledge of physiology, pathway regulation and control, and the design of creative screening procedures. In addition, it requires mastery of the fermentation process for each new strain, as well as sound engineering know-how for mediaoptimization and the fine-tuning of process conditions. This review focuses on the various options that may be employed to improve microbial strains and addresses the complex problems of screening, the tools and technology behind the selection of targeted organisms, and the importance of process optimization. Furthermore, this review discusses new and emerging technologies and designing optimized media for tracking mutants with enhanced productivity or other desired attributes.
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Affiliation(s)
- S Parekh
- Natural Products Development Group, Dow AgroSciences LLC, Indianapolis, IN 46268-1504, USA.
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Abstract
Peyronie's disease is an idiopathic disorder in which an inflammatory fibrosis occurs in the tunica albuginea of the corpora cavernosa which causes the erect penis to become deformed. Peyronie's disease has a prevalence of 1% in men over age 50 years. Paget's disease of bone is a chronic skeletal disease with areas of increased bone turnover leading to pain, deformity, and in some cases arthritis. Because of a high rate of Peyronie's disease in subjects in a Paget's disease industry-sponsored drug trial, we asked whether there was an association between Peyronie's disease and Paget's disease of bone. We evaluated 61 men with Paget's disease attending our clinic for metabolic bone disease in a tertiary referral hospital, reviewed hospital records of all men discharged from our three hospitals with the diagnosis of Peyronie's disease, and mailed a validated questionnaire about shape of the erect penis to 1500 male members of the Paget Foundation. In the clinic population of men with Paget's disease of bone, 51 of 61 (83.6%) reported having normal erections; 10 patients (16.4%) were impotent. Sixteen of the 51 men (31.4%) had developed a bend or deformity in their erect penis which was confirmed by a urologist's examination to be Peyronie's disease. When the men with Paget's disease with and without Peyronie's disease were compared, there was no difference in their ages, years with Paget's disease, or serum alkaline phosphatase level. Upon medical record review, 1 patient of 262 (0.4%) with Peyronie's disease was found to have Paget's disease of bone. The men with Paget's disease returned their questionnaires for a response rate of 44.8% and reported Peyronie's disease with a prevalence of 14.5%. We suggest that Peyronie's disease is associated with Paget's disease of bone. Furthermore, we suggest that Peyronie's disease may be a previously unrecognized complication of Paget's disease of bone.
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Affiliation(s)
- K W Lyles
- GRECC, VA Medical Center, Durham, North Carolina, USA
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Affiliation(s)
- M Cheryan
- Agricultural Bioprocess Laboratory, University of Illinois, Urbana 61801, USA
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