1
|
Short RT, Lin F, Nair S, Terry JG, Carr JJ, Kandula NR, Lloyd-Jones D, Kanaya AM. Comparing coronary artery cross-sectional area among asymptomatic South Asian, White, and Black participants: the MASALA and CARDIA studies. BMC Cardiovasc Disord 2024; 24:158. [PMID: 38486153 PMCID: PMC10938784 DOI: 10.1186/s12872-024-03811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/22/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND South Asian individuals have high risk of atherosclerotic cardiovascular disease (ASCVD). Some investigators suggest smaller coronary artery size may be partially responsible. METHODS We compared the left anterior descending (LAD) artery cross-sectional area (CSA) (lumen and arterial wall) among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study with White and Black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, adjusting for BMI, height, and other ASCVD risk factors. We used thin-slice non-contrast cardiac computed tomography to measure LAD CSA. We used linear regression models to determine whether race/ethnicity was associated with LAD CSA after adjusting for demographic factors, BMI, height, coronary artery calcium (CAC), and traditional cardiovascular risk factors. RESULTS Our sample included 3,353 participants: 513 self-identified as South Asian (44.4% women), 1286 as Black (59.6% women), and 1554 as White (53.5% women). After adjusting for age, BMI, height, there was no difference in LAD CSA between South Asian men and women compared to White men and women, respectively. After full adjustment for CVD risk factors, LAD CSA values were: South Asian women (19.9 mm2, 95% CI [18.8 - 20.9]) and men (22.3 mm2, 95% CI [21.4 - 23.2]; White women (20.0 mm2, 95% CI [19.4-20.5]) and men (23.6 mm2, 95% CI [23.0-24.2]); and Black women (21.6 mm2, 95% CI [21.0 - 22.2]) and men (26.0 mm2, 95% CI [25.3 - 26.7]). Height, BMI, hypertension, CAC, and age were positively associated with LAD CSA; current and former cigarette use were inversely associated. CONCLUSIONS South Asian men and women have similar LAD CSA to White men and women, and smaller LAD CSA compared to Black men and women, respectively, after accounting for differences in body size. Future studies should determine whether LAD CSA is associated with future ASCVD events.
Collapse
Grants
- R01 HL093009 NHLBI NIH HHS
- UL1 RR024131 NCRR NIH HHS
- K24 HL112827 NHLBI NIH HHS
- P30 DK098722 NIDDK NIH HHS
- P30 DK092924 NIDDK NIH HHS
- 2R01HL093009, UL1TR001872, 5K24HL112827, HHSN268201800005I, HHSN268201800007I, HHSN268201800003I, HHSN268201800006I, HHSN268201800004I, R01-HL098445 NHLBI NIH HHS
- National Heart, Lung, and Blood Institute
Collapse
Affiliation(s)
- R T Short
- University of California San Francisco, San Francisco, USA.
| | - F Lin
- University of California San Francisco, San Francisco, USA
| | - S Nair
- Vanderbilt University Medical Center, Nashville, USA
| | - J G Terry
- Vanderbilt University Medical Center, Nashville, USA
| | - J J Carr
- Vanderbilt University Medical Center, Nashville, USA
| | | | | | - A M Kanaya
- University of California San Francisco, San Francisco, USA
| |
Collapse
|
2
|
Maniero C, Ng SM, Collett G, Godec T, Siddiqui I, Antoniou S, Kumar A, Janmohamed A, Nair S, Kotecha A, Khan R, Khanji MY, Kapil V, Gupta J, Gupta AK. Differential impact of COVID-19 on mental health and burnout. Occup Med (Lond) 2024; 74:45-52. [PMID: 37040624 PMCID: PMC10875923 DOI: 10.1093/occmed/kqad011] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles. AIMS To examine mental health and burnout rates, and possible drivers for any disparities between professional roles. METHODS In this cohort study, online surveys were distributed to HCPs in July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 2020) assessing for probable major depressive disorder (MDD), generalized anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional exhaustion and depersonalization). Separate logistic regression models (at both phases) compared the risk of outcomes between roles: healthcare assistants (HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and doctors (reference group). Separate linear regression models were also developed relating the change in scores to professional role. RESULTS At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 736), the disproportionate risk between doctors and others worsened: nurses and HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. Nurses also had a significantly increased risk of MDD, GAD, poor mental well-being and burnout. Nurses also had significantly worsened anxiety, mental well-being and burnout scores over time, relative to doctors. CONCLUSIONS Nurses and AHPs had excess risk of adverse mental health and burnout during the pandemic, and this difference worsened over time (in nurses especially). Our findings support adoption of targeted strategies accounting for different HCP roles.
Collapse
Affiliation(s)
- C Maniero
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - S M Ng
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - G Collett
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - T Godec
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - I Siddiqui
- Wellbeing Hub, Newham Training Hub, London E15 1HP, UK
- Northeast London CCG, London E15 1DA, UK
- Woodgrange Medical Practice, London E7 0QH, UK
| | - S Antoniou
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - A Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan WN1 1XX, UK
| | - A Janmohamed
- St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - S Nair
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Wales LL18 5UJ, UK
| | - A Kotecha
- Royal Devon and Exeter Hospital, Exeter, Devon EX2 5DW, UK
| | - R Khan
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - M Y Khanji
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- UCLPartners, London W1T 7HA, UK
- Newham University Hospital, Barts Health NHS Trust, London E13 8SL, UK
| | - V Kapil
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - J Gupta
- South West London and St George’s Mental Health NHS Trust, London SW17 0YF, UK
| | - A K Gupta
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| |
Collapse
|
3
|
Sharp A, Matthews G, Papageorgiou N, Till R, Raine D, Williams I, Grahame-Clarke C, Nair S, Abdul-Samad O, Vassiliou V, Garg P, Lim WY. Hospitalization for permanent pacemaker implantation in the context of isolated sinus node dysfunction is associated with increased mortality compared with an outpatient strategy. Pacing Clin Electrophysiol 2023; 46:1465-1471. [PMID: 37910470 DOI: 10.1111/pace.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Permanent pacemaker (PPM) implantation is a well-established treatment for symptomatic sinus node dysfunction (SND). The optimal timing of this intervention is unclear, with atrioventricular blocks often prioritized in resource stressed waiting lists due to mortality concerns. METHODS Mortality data was compared between patients receiving elective outpatient (OP) PPM implantation, and those presenting to hospital for urgent inpatient (IP) management for symptomatic SND. Survival analysis was conducted using Kaplan-Meier plots and compared using the log-rank test. Univariable and multivariable Cox regression, as well as propensity score matching analyses were performed to assess the prognostic effect on 30-day and 1-year all-cause mortality of inpatient implant. RESULTS Of the 1269 patients identified with isolated SND, 740 (58%) had PPMs implanted on an OP and 529 (42%) on an IP basis. Mortality was significantly worse in patients where management was driven by hospital admission on an urgent basis (Log-Rank χ2 = 21.6, p < 0.001) and remained an independent predictor of 1-year all-cause mortality (HR 3.40, 95% CI 1.97-5.86, p < 0.001) on multivariable analysis. CONCLUSIONS SND is predominantly a disease associated with ageing and comorbid populations, where avoidance of deconditioning, hospitalization acquired infections, and polypharmacy is advantageous. Admission avoidance is therefore the preferable strategy.
Collapse
Affiliation(s)
- Alexander Sharp
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Gareth Matthews
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
- Department of Cardiology, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Richard Till
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Daniel Raine
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Ian Williams
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | | | - Santosh Nair
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Omar Abdul-Samad
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Vassilios Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
- Department of Cardiology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
- Department of Cardiology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Wei Yao Lim
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| |
Collapse
|
4
|
Haverkos B, Alpdogan O, Baiocchi R, Brammer JE, Feldman TA, Capra M, Brem EA, Nair S, Scheinberg P, Pereira J, Shune L, Joffe E, Young P, Spruill S, Katkov A, McRae R, Royston I, Faller DV, Rojkjaer L, Porcu P. Targeted therapy with nanatinostat and valganciclovir in recurrent EBV-positive lymphoid malignancies: a phase 1b/2 study. Blood Adv 2023; 7:6339-6350. [PMID: 37530631 PMCID: PMC10587711 DOI: 10.1182/bloodadvances.2023010330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/30/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
Lymphomas are not infrequently associated with the Epstein-Barr virus (EBV), and EBV positivity is linked to worse outcomes in several subtypes. Nanatinostat is a class-I selective oral histone deacetylase inhibitor that induces the expression of lytic EBV BGLF4 protein kinase in EBV+ tumor cells, activating ganciclovir via phosphorylation, resulting in tumor cell apoptosis. This phase 1b/2 study investigated the combination of nanatinostat with valganciclovir in patients aged ≥18 years with EBV+ lymphomas relapsed/refractory to ≥1 prior systemic therapy with no viable curative treatment options. In the phase 1b part, 25 patients were enrolled into 5 dose escalation cohorts to determine the recommended phase 2 dose (RP2D) for phase 2 expansion. Phase 2 patients (n = 30) received RP2D (nanatinostat 20 mg daily, 4 days per week with valganciclovir 900 mg orally daily) for 28-day cycles. The primary end points were safety, RP2D determination (phase 1b), and overall response rate (ORR; phase 2). Overall, 55 patients were enrolled (B-non-Hodgkin lymphoma [B-NHL], [n = 10]; angioimmunoblastic T-cell lymphoma-NHL, [n = 21]; classical Hodgkin lymphoma, [n = 11]; and immunodeficiency-associated lymphoproliferative disorders, [n = 13]). The ORR was 40% in 43 evaluable patients (complete response rate [CRR], 19% [n = 8]) with a median duration of response of 10.4 months. For angioimmunoblastic T-cell lymphoma-NHL (n = 15; all refractory to the last prior therapy), the ORR/CRR ratio was 60%/27%. The most common adverse events were nausea (38% any grade) and cytopenia (grade 3/4 neutropenia [29%], thrombocytopenia [20%], and anemia [20%]). This novel oral regimen provided encouraging efficacy across several EBV+ lymphoma subtypes and warrants further evaluation; a confirmatory phase 2 study (NCT05011058) is underway. This phase 1b/2 study is registered at www.clinicaltrials.gov as #NCT03397706.
Collapse
Affiliation(s)
| | - Onder Alpdogan
- Division of Hematologic Malignancies and Hematopoetic Stem Cell Transplantation, Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Robert Baiocchi
- The Ohio State University James Comprehensive Cancer Center, Columbus, OH
| | | | - Tatyana A. Feldman
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Marcelo Capra
- Centro Integrado de Hematologia e Oncologia - Hospital Mãe de Deus, Porto Alegre, Brazil
| | - Elizabeth A. Brem
- Division of Hematology/Oncology, Deptartment of Medicine, University of California, Irvine, Orange, CA
| | - Santosh Nair
- Mid Florida Hematology and Oncology Center, Orange City, FL
| | - Phillip Scheinberg
- Division of Hematology, Hospital A Beneficência Portuguesa, São Paulo, Brazil
| | - Juliana Pereira
- Division of Hematology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Leyla Shune
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, KS
| | - Erel Joffe
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | - Pierluigi Porcu
- Division of Hematologic Malignancies and Hematopoetic Stem Cell Transplantation, Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| |
Collapse
|
5
|
Prashanth RR, Nair S, Haribalakrishna A, Thakkar H. How early is too early? Diagnosis of tuberous sclerosis complex in a neonate. J Postgrad Med 2023; 69:243-244. [PMID: 37675664 PMCID: PMC10846816 DOI: 10.4103/jpgm.jpgm_326_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/01/2023] [Accepted: 05/29/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- RR Prashanth
- Department of Neonatology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - S Nair
- Department of Neonatology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - A Haribalakrishna
- Department of Neonatology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - H Thakkar
- Department of Radiology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
6
|
Rakesh PS, Nair S, Kamala R, Manu MS, Mrithunjayan SK, Valamparampil MJ, Kutty VR, Sadanandan R. Local government stewardship for TB elimination in Kerala, India. Public Health Action 2023; 13:44-50. [PMID: 36949740 PMCID: PMC9983805 DOI: 10.5588/pha.22.0037] [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: 05/15/2022] [Accepted: 10/04/2022] [Indexed: 03/07/2023] Open
Abstract
SETTING The southern Indian state of Kerala has implemented 'Kerala Tuberculosis Elimination Mission' as 'People's Movement against TB' under the stewardship of local governments (LGs). The state has been certified by the Government of India for being on track to attain the UN Sustainable Development Goals related to TB elimination. OBJECTIVE To document the role of LG stewardship in the successful implementation of the TB elimination activities in Kerala. DESIGN 1) Key informant interviews with four state officials, 2) desk review of available documents, 3) in-depth interviews with seven LG leaders, three mid-level programme managers and three health department field staff. RESULTS LG involvement led to the establishment of solutions based on local problems, enhanced outreach of services to the socially vulnerable individuals, improved treatment support to patients with TB, increased community ownership of TB elimination activities, reduced TB-related stigma and social determinants being addressed. Institutional mechanisms such as LG TB elimination task forces, formal guidance in planning interventions and appreciation of their performance in the form of awards were facilitators for LG involvement. CONCLUSION LG stewardship can accelerate TB elimination. A good plan for engagement and institutional mechanisms are crucial for LG involvement.
Collapse
Affiliation(s)
- P S Rakesh
- WHO Technical Support Network, State TB Cell, Thiruvananthapuram, India
| | - S Nair
- Department of Pulmonary Medicine, Government Medical College, Thrissur, India
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
| | - R Kamala
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
- Department of Pulmonary Medicine, Government Medical College, Thiruvananthapuram, India
| | - M S Manu
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
- Directorate of Health Services, State TB Cell, Thiruvananthapuram, India
| | - S K Mrithunjayan
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
- Directorate of Health Services, State TB Cell, Thiruvananthapuram, India
| | - M J Valamparampil
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
- Directorate of Health Services, State TB Cell, Thiruvananthapuram, India
| | - V Raman Kutty
- Decentralisation Study Group, Health Action by People, Thiruvananthapuram, India
| | - R Sadanandan
- Health Systems Transformation Platform, New Delhi, India
| |
Collapse
|
7
|
Prajitha KC, Babu V, Rahul A, Valamparampil MJ, Sreelakshmi PR, Nair S, Varma RP. Combatting emerging infectious diseases from Nipah to COVID-19 in Kerala, India. Public Health Action 2023; 13:32-36. [PMID: 36949738 PMCID: PMC9983808 DOI: 10.5588/pha.22.0024] [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: 05/01/2022] [Accepted: 09/20/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND The state of Kerala, India, has experienced several unprecedented events in the past few years. The current study was an attempt to explore perceptions of stakeholders on how the decentralised system helped during the Nipah virus (NiV) outbreaks and COVID-19 pandemic in Kerala. METHODS This study used a qualitative descriptive approach built on the advocacy paradigm. The stakeholders who were involved in decision-making and the representatives of local self-government who had real-time experience and had handled the challenges were identified using purposive sampling. Seven key informant interviews (KIIs) and nine in-depth interviews (IDIs) were conducted. RESULTS Findings indicate that decentralisation had enabled the state to effectively deal with the outbreaks and the pandemic. The survey revealed four major themes: decision-making, engagement level, people-centric action, and difficulties. Two to four categories have emerged for each theme. CONCLUSION The study results highlight the importance of human resources and service delivery as balancing factors during public health emergencies in any developing nation with limited resources. Given that very few nations have the healthcare infrastructure and resources necessary to cater to the healthcare needs of the whole population, decentralisation should be reinforced.
Collapse
Affiliation(s)
- K C Prajitha
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, India
| | - V Babu
- Comprehensive Stroke Care Programme, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India
| | - A Rahul
- Indian Council of Medical Research Vector Control Research Centre, Puducherry, India
| | - M J Valamparampil
- State Consultant for Health and Wellness Centres, National Health Mission, Thiruvananthapuram, India
| | | | - S Nair
- Department of Respiratory Medicine, Government Medical College, Thrissur, India
| | - R P Varma
- Achutha Menon Centre for Health Science Studies, SCTIMST, Thiruvananthapuram, India
| |
Collapse
|
8
|
Kamala R, Ravindran RM, Krishnan RA, Nair S, Varma RP, Srilatha S, Iype T, Vidhukumar K. Role of decentralised governance in implementing the National AIDS Control Programme in Kerala. Public Health Action 2023; 13:1-5. [PMID: 36949742 PMCID: PMC9983810 DOI: 10.5588/pha.22.0029] [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: 05/03/2022] [Accepted: 07/11/2022] [Indexed: 03/07/2023] Open
Abstract
SETTING In alignment with the UN Sustainable Development Goals (SDGs), Kerala State in India aims to end the HIV/AIDS epidemic, using its strong background in local governance to implement the National AIDS Control Programme (NACP). OBJECTIVE To examine the role of local governments in the implementation of NACP in tune with SDGs. DESIGN We conducted a state-wide exploratory study using document reviews, key informant and in-depth interviews, which were analysed thematically. RESULTS Four overarching themes that emerged were 1) preparation for programme implementation, 2) positive impact of local government involvement, 3) convergence with other organisations, and 4) barriers to implementation. Local government commitment to implementing the programme was evidenced by their adoption of the HIV/AIDS policy, facilitative interdepartmental coordination and local innovations. Interventions focused on improving awareness about the disease and treatment, and social, financial and rehabilitative support, which were extended even during the COVID-19 pandemic. Fund shortages and poor visibility of the beneficiaries due to preference for anonymity were challenges to achieving the expected outcomes. CONCLUSION The NACP is ably supported by local governments in its designated domains of interventions, prevention, treatment, and care and support. The programme can achieve its target to end the AIDS epidemic by overcoming the stigma factor, which still prevents potential beneficiaries from accessing care.
Collapse
Affiliation(s)
- R Kamala
- Health Action by People, Thiruvananthapuram, India
- Department of Pulmonary Medicine, Government Medical College, Thiruvananthapuram, India
| | - R M Ravindran
- Health Action by People, Thiruvananthapuram, India
- State Health Systems Resource Centre, Thiruvananthapuram, Kerala, India
| | - R A Krishnan
- State Health Systems Resource Centre, Thiruvananthapuram, Kerala, India
| | - S Nair
- Health Action by People, Thiruvananthapuram, India
- Department of Pulmonary Medicine, Government Medical College, Thrissur, India
| | - R P Varma
- Health Action by People, Thiruvananthapuram, India
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - S Srilatha
- Health Action by People, Thiruvananthapuram, India
| | - T Iype
- Health Action by People, Thiruvananthapuram, India
- Department of Neurology, Government Medical College, Thiruvananthapuram, India
| | - K Vidhukumar
- Health Action by People, Thiruvananthapuram, India
- Department of Psychiatry, Government Medical College, Thiruvananthapuram, India
| |
Collapse
|
9
|
Mirrahimi A, Stella S, de Souza R, Nair S, Markose G, Yip G, Gastaldo F. Abstract No. 34 Comparison of Type II Endoleak Treatment: Direct Sac Puncture versus Transarterial Embolization: A Retrospective Cohort Analysis. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
|
10
|
Dong M, Hu N, Hua Y, Xu X, Kandadi M, Guo R, Jiang S, Nair S, Hu D, Ren J. Erratum to: “Chronic Akt activation attenuated lipopolysaccharide-induced cardiac dysfunction via Akt/GSK3β-dependent inhibition of apoptosis and ER stress” [Biochim. Biophys. Acta. 1832(6) 2013 Jun; 848–63. doi:10.1016/j.bbadis.2013.02.023. Epub 2013 Mar 6.PMID: 23474308]. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166567. [DOI: 10.1016/j.bbadis.2022.166567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
11
|
Nair S, Abraham J. Bioproduction and Characterization of Pigments from Streptomyces sp. Isolated from Marine Biotope. APPL BIOCHEM MICRO+ 2022. [DOI: 10.1134/s0003683822060114] [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: 12/07/2022]
|
12
|
Praseetha NG, Divya UK, Nair S. Identifying the potential role of curcumin analogues as anti-breast cancer agents; an in silico approach. Egypt J Med Hum Genet 2022. [DOI: 10.1186/s43042-022-00312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breast cancer ranks top among newly reported cancer cases and most of the women suffers from breast cancer. Development of target therapy using phytochemicals with minimal side effects is trending in health care research. Phytochemicals targets complex multiple signalling events in cancer and are pleiotropic in nature. Thus, the present study was conducted to check the effectivity of curcumin analogues (Capsaicin, Chlorogenic acid, Ferulic acid, Zingerone, Gingerol) against the receptors that are expressed in breast cancer cells and prove its ethno-medicinal value by using bioinformatic tools and softwares like PDB, Patch Dock, PubChem, Chimera and My Presto.
Result
Out of the various curcumin analogues studied, Ferulic acid showed best binding affinity with all the breast cancer cell specific receptors (FGF, MMP9, RNRM1, TGF-beta, DHFR, VEGF and aromatase) which was confirmed through the docking studies.
Conclusion
The current work was a preliminary step towards screening suitable drug candidate against breast cancer using in silico methods. This information can be used further to carry out in vivo studies using selected natural analogues of curcumin as a suitable drug candidate against breast cancer saving time and cost.
Collapse
|
13
|
Haque Y, Cao Y, Lominska C, Chung C, Pickard A, Bur A, Thomas S, Woodroof J, Yilmaz E, Neupane P, McCance D, Rosenthal D, Nair S, Thorstad W, Garden A, Caudell J, Wong S, Bonner J, Harris J, Gan G. A Retrospective Analysis of NRG/RTOG 0522: Low Myofibroblast Content in the Tumor-Associated Stroma may Predict Response to Epidermal Growth Factor Receptor (EGFR) Inhibitors. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
14
|
Girard N, Besse B, Bernabé Caro R, Goto K, Leighl N, Ohe Y, Sabari J, Lee SH, Lin X, Schaeffer M, Nair S, Li T, Di Scala L, Potluri R, Mahadevia P, Thayu M, Kim T. EP08.02-016 Frontline and Post-Osimertinib Therapy for EGFR-mutant Advanced NSCLC: Treatment Patterns, Outcomes, Healthcare Use and Costs. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.698] [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: 10/14/2022]
|
15
|
Varadi M, Deshpande M, Nair S, Anyango S, Bertoni D, Velankar S. High-accuracy protein structure models in AlphaFold DB. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322093044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
|
16
|
Mewada M, Sanyal S, Rangarajan S, Apsangikar P, Yadav AK, Naik M, Nair S. A prospective, multicenter, clinical Study to evaluate the Safety, Pharmacokinetics, and Efficacy of Bleed Outcomes, with HemoRel-A® in severe Hemophilia A Patients. J Assoc Physicians India 2022; 70:11-12. [PMID: 35833399 DOI: 10.5005/japi-11001-0039] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate efficacy for an on-demand treatment of acute bleeding events, pharmacokinetics, safety, and tolerability of HemoRel-A® in severe hemophilia A. METHODS A total of 44 male subjects with severe hemophilia A with an annualized bleed rate of 12 while on-demand treatment with factor VIII (FVIII) were enrolled in the study and received HemoRel-A® for bleed treatment. The efficacy of HemoRel-A® was evaluated based on a four-point scale (excellent, good, moderate, or none). Six-point pharmacokinetic (PK) assessment was performed following a single dose of 50 IU/kg in 12 subjects after a 7-day wash-out period. Safety evaluations were performed at each visit and inhibitor testing was performed in all patients at screening and end of study. RESULTS Forty-four male subjects received at least a single dose of the study medication and were included in the intent-to-treat (ITT) analysis and safety outcome. In 23 (7.52%) out of the 306 bleeding events, HemoRel-A® efficacy was rated as excellent, in 272 (88.89 %) bleeds it was rated as good, and in 11 (3.68%) bleeding events it was rated as moderate. No failure of efficacy was noted in any of the bleeding events. Thus overall out of 306 bleeding events, 295 (96.41%) showed excellent or good efficacy. Pharmacokinetic assessment based on plasma FVIII activity measured by the chromogenic assay in 12 patients showed comparative results similar to FVIII preparations. A total of 12 adverse events (AEs) were reported in this study. There was no inhibitor development in this previously treated patients (PTP) cohort. CONCLUSION HemoRel-A® was established to be efficacious and safe in the treatment of acute bleeding events in subjects with severe hemophilia A. TRIAL REGISTRATION NUMBER CTRI/2018/05/013790. Registration date: 9th May 2018.
Collapse
Affiliation(s)
- Mayur Mewada
- Assistant Professor, Department of Medicine, KJ Somaiya Medical College, Hospital and Research Centre
| | - Subhaprakash Sanyal
- Consultant Hematologist and Hemato-Oncologist, Fortis Hospitals Limited, Mumbai, Maharashtra, India
| | | | | | | | | | - Santosh Nair
- Divisional Medical Head, Reliance Life Sciences Pvt. Ltd., Navi Mumbai, Maharashtra, India
| |
Collapse
|
17
|
Rahmati M, Ripanelli A, Nair S, Gill A, Linara-Demakakou E, Ahuja K, Macklon N. P-335 How to define recurrent implantation failure and when to start investigating the endometrium? Lessons from three years’ experience in a dedicated unit. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Should we always define recurrent implantation failure (RIF) after three unsuccessful transfers and only then start investigating the endometrium?
Summary answer
Endometrial investigations can be beneficial for patients with RIF. However, waiting for three previous failures before instituting assessment might not be appropriate in every situation.
What is known already
The definition of unexplained recurrent implantation failure (RIF) continues to be debated. This usually implies a lack of embryo implantation after the transfer of three good quality blastocysts on an apparently responsive and anatomically normal endometrium. To deal with this frustrating and distressing situation for both the patient and the clinician, additional empirical interventions are often blindly used. This approach may exacerbate rather than ameliorate any underlying aetiology. There is a need therefore to base interventions on diagnostic rationale wherever possible.
Study design, size, duration
In order to base advice and any interventions for RIF on diagnostic rationale, we created a referral unit dedicated to the investigation and treatment of patients meeting the traditional criteria for RIF. Over three years, 395 patients were referred to this unit and 237 completed their investigations. Here we present the clinical outcomes and insights obtained over these three years.
Participants/materials, setting, methods
Blood sampling for serum progesterone level and endometrial pipelle biopsy were performed after five days of luteal support in a standardised substituted cycle. The samples underwent dating by gene expression (ERA test) and immune assessment describing the recruitment and activation of the uterine Natural Killer cells (MLI test, Matrice Lab Innove). A personalised treatment plan was thus derived and suggested to the referring clinician. The outcomes after the subsequent personalised single embryo transfer were monitored.
Main results and the role of chance
The patients referred had an average of 4.3 previous good quality blastocysts transferred in the past. 58% of the referred patients had used their own eggs, including 49% after conventional IVF or ICSI, and 9% after using PGT-A. 42% of the referred patients had used donor eggs. To date, 237 patients completed their endometrial assessment. 92% of the tested patients revealed at least one disrupted endometrial marker. With the subsequent personalised single embryo transfer, an implantation rate of 58% was observed. The ongoing pregnancy rate at 12 weeks was reported at 39%.
Limitations, reasons for caution
While confirmatory prospective controlled studies are required, these data indicate that more targeted rather than blind usage of simple known therapeutics could be beneficial for patients experiencing RIF. The clinical context these referred was highly variable, including patients undergoing PGT-A and egg donation.
Wider implications of the findings
Given the higher implantation rates to be expected in some groups, waiting for at least three embryos to fail before investigating the endometrium may be inappropriate and underlie the relatively high miscarriage rate observed. The investigation of implantation failure should be driven by context rather than arbitrary definition.
Trial registration number
Not Applicable
Collapse
Affiliation(s)
- M Rahmati
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| | - A Ripanelli
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| | - S Nair
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| | - A Gill
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| | | | - K Ahuja
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| | - N Macklon
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| |
Collapse
|
18
|
Bodri D, Pataia V, Linara-Demakakou E, Kováts T, Vendola M, Wolska M, Nair S, Macklon N, Ahuja K. P-592 The effect of ethnicity on ovarian stimulation outcomes of altruistic oocyte donors from the largest UK vitrified egg bank: a retrospective cohort study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Are there differences in ovarian stimulation outcomes among different ethnicities in the largest UK vitrified oocyte donation programme?
Summary answer
No significant differences were observed in ovarian response between non-White and White ethnic donor groups. Only AMH and baseline AFC correlated well with ovarian response.
What is known already
Ethnic disparities in ART outcomes have received much attention recently. Studies based on national registries have reported inferior outcomes for South Asian and Black ethnicities undergoing non-donor IVF treatment. Ovarian response has also been reported to differ across ethnicities, which was attributed to genetic or environmental factors, but also ethnic differences in ovarian reserve markers and body weight. A few US studies have evaluated recipient outcomes in oocyte donation treatment and found lower success rates for Black recipients. So far, no large study has evaluated the effect of ethnicity on ovarian response in a large cohort of oocyte donors.
Study design, size, duration
All consecutive oocyte donation cycles (n = 1.421) from the UK’s largest, private vitrified egg bank between 2017 and 2021 were included in this retrospective cohort analysis. Donors underwent general health evaluation, ovarian reserve (AMH, AFC) and infectious disease screening. Ovarian stimulation with recFSH was commenced on cycle day 2-3, with starting doses ranging from 112.5-450 IU. GnRH antagonist was given from day 6, and final oocyte maturation was triggered with a GnRH agonist (0.5 ml buserelin).
Participants/materials, setting, methods
Altruistic oocyte donors (n = 1.027) were stratified according to ethnicity; White (77%), mixed (7.4%), Black (5.4%), South-Asian (4.1 %), other Asian (3.5%) and South American (2.2%). In a univariate analysis, Kruskal-Wallis test was applied to compare age, BMI, AMH between ethnic groups and total and mature oocyte number during treatment cycles. In a multi-variate analysis, the effect of ethnicity, age, BMI, AMH and baseline AFC was evaluated on the number of total and mature oocytes obtained.
Main results and the role of chance
Univariate analysis showed no difference between ethnic groups in BMI (total average:23.5±3.1) AMH (total average:29.5±16.0 pmol/L) whereas other Asians were older (30.5±4.6 years, p < 0.001) and South Americans younger (24.4±4.7 years, p = 0.005) compared to Whites (27.1±4.6 years). The total number of eggs retrieved did not differ significantly between ethnic groups; White:19.6±9.1, mixed:19.6±9.0, Black:20.1±10.3, South-Asian:18±8.3, other Asian: 17.6±8.8 and South American:17.7±8.4, p = 0.24). The same applied to mature eggs obtained: White:14.2±7.1, mixed:13.9±7.2, Black:12.7±7.1, South-Asian:13.4±7.1, other Asian: 13±7.2, South American:12.8±7.1, p = 0.19). However, oocyte maturity rate was significantly lower in Black compared to White donors (64±19% vs 73±18%, p = 0.003). In a multivariate analysis, only baseline AFC (p < 0.0001) and AMH (p < 0.0001) correlated well with either the number of retrieved total or mature eggs.
Limitations, reasons for caution
Retrospective cohort studies might have inherent biases that make comparisons difficult. Slightly different inclusion criteria (age, AMH) for different ethnicities might have affected ovarian stimulation outcomes. The size of some subgroups was too low to yield statistically meaningful results. Some baseline donor variables were not included in our analysis.
Wider implications of the findings
Ovarian response outcomes were not substantially different across various ethnic groups of altruistic, UK oocyte donors. This study indicates that reported ethnic differences in IVF outcomes is unlikely to be due to response to ovarian stimulation. Donor egg programs can anticipate similar numbers of eggs irrespective of donor ethnicity.
Trial registration number
n/a
Collapse
Affiliation(s)
- D Bodri
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - V Pataia
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | | | - T Kováts
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - M Vendola
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - M Wolska
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - S Nair
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - N Macklon
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - K Ahuja
- London Womens Clinic, London Egg Bank , London, United Kingdom
| |
Collapse
|
19
|
Wu K, Caterine S, Markose G, Nair S, Stella SF. Abstract No. 546 Comparison of thermal ablation therapies for painful extraspinal bone metastases: a systematic review. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
20
|
Wilks C, Nair S, Markose G, Stella S. Abstract No. 165 Combined thermal ablation and embolization for the treatment of hepatocellular carcinoma: a retrospective review in a tertiary cancer center. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
21
|
Agarwal J, Sinha S, Lewis Salins S, Pandey S, Deodhar J, Salins N, Ghosh Laskar S, Budrukkar A, Gupta T, Murthy V, Swain M, Nair S, Chaturvedi P. OC-0592 Impact of palliative care referral on distress in patients undergoing RT for HNSCC: Randomized Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02614-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
22
|
Schjesvold FH, Dimopoulos MA, Delimpasi S, Robak P, Coriu D, Legiec W, Pour L, Špička I, Masszi T, Doronin V, Minarik J, Salogub G, Alekseeva Y, Lazzaro A, Maisnar V, Mikala G, Rosiñol L, Liberati AM, Symeonidis A, Moody V, Thuresson M, Byrne C, Harmenberg J, Bakker NA, Hájek R, Mateos MV, Richardson PG, Sonneveld P, Schjesvold F, Delimpasi S, Robak P, Coriu D, Nikolayeva A, Tomczak W, Pour L, Spicka I, Dimopoulos MA, Masszi T, Doronin V, Minarik J, Salogub G, Alekseeva Y, Maisnar V, Mikala G, Rosinol L, Konstantinova T, Lazzaro A, Liberati AM, Symeonidis A, Gatt M, Illes A, Abdulhaq H, Dungarwalla M, Grosicki S, Hajek R, Leleu X, Myasnikov A, Richardson PG, Avivi I, Deeren D, Gironella M, Hernandez-Garcia MT, Martinez Lopez J, Newinger-Porte M, Ribas P, Samoilova O, Voog E, Arnao-Herraiz M, Carrillo-Cruz E, Corradini P, Dodlapati J, Granell Gorrochategui M, Huang SY, Jenner M, Karlin L, Kim JS, Kopacz A, Medvedeva N, Min CK, Mina R, Palk K, Shin HJ, Sohn SK, Sonneveld P, Tache J, Anagnostopoulos A, Arguiñano JM, Cavo M, Filicko J, Garnes M, Halka J, Herzog-Tzarfati K, Ipatova N, Kim K, Krauth MT, Kryuchkova I, Lazaroiu MC, Luppi M, Proydakov A, Rambaldi A, Rudzianskiene M, Yeh SP, Alcalá-Peña MM, Alegre Amor A, Alizadeh H, Bendandi M, Brearton G, Brown R, Cavet J, Dally N, Egyed M, Hernández-Rivas JÁ, Kaare A, Karsenti JM, Kloczko J, Kreisle W, Lee JJ, Legiec W, Machherndl-Spandl S, Manda S, Mateos MV, Moiseev I, Moreb J, Nagy Z, Nair S, Oriol-Rocafiguera A, Osswald M, Otero-Rodriguez P, Peceliunas V, Plesner T, Rey P, Rossi G, Stevens D, Suriu C, Tarella C, Verlinden A, Zannetti A. Melflufen or pomalidomide plus dexamethasone for patients with multiple myeloma refractory to lenalidomide (OCEAN): a randomised, head-to-head, open-label, phase 3 study. The Lancet Haematology 2022; 9:e98-e110. [DOI: 10.1016/s2352-3026(21)00381-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/30/2022]
|
23
|
Soden L, Ha F, Nair S, Whitbourn R, Palmer S. Next-Day Discharge Following Transcatheter Aortic Valve Implantation: An Australian Tertiary Hospital Experience. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
24
|
Pearce J, Swinson D, Cairns D, Nair S, Baxter M, Petty R, Seymour M, Hall P, Velikova G. Frailty and treatment outcome in advanced gastro-oesophageal cancer: an exploratory analysis of the GO2 trial. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
25
|
Pearce J, Hatton N, Barlow V, Lad H, Nair S, Swinson D. Leeds Oncology Frailty Initiative (LOFrI): development of a pilot service for frail patients with gastrointestinal malignancy. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
26
|
Lundon DJ, Kelly BD, Nair S, Bolton DM, Kyprianou N, Wiklund P, Tewari A. Early mortality risk stratification after SARS-CoV-2 infection. Med Intensiva 2021; 45:e40-e42. [PMID: 34717886 PMCID: PMC8549443 DOI: 10.1016/j.medine.2020.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- D J Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
| | - B D Kelly
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - S Nair
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - D M Bolton
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - N Kyprianou
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - P Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - A Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
| |
Collapse
|
27
|
Hey C, Zahoor S, Shreeve J, Gomes L, Varghese S, Alam T, Zaman J, Nair S. Improving the quality of discharge care plan in the heart failure with reduced ejection fraction (HFrEF) cohort: a quality improvement study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
High-quality heart failure (HF) discharge summary (DS) is the cornerstone of effective communication during the transition from specialists to primary care. The combination of continuing involvement of multidisciplinary members, varying individual tolerance to treatments, and the need for multiple investigations beget intricate HFrEF management. The quality of the information included in DS following HF-related hospitalisation varies widely and may be sub-optimal in communicating patient's in-hospital care, leading to inadequate compliance to guideline-directed medical therapy (GDMT) and increased risk of re-hospitalisation. Notwithstanding this real-world observation, there remains a paucity of consensus on the standard of measurements of HF DS.
Purpose
We aimed to optimise the transmission of information between patients and HF multidisciplinary members to improve adherence to GDMT, follow-up (F/U) care coordination and patient education in line with the National Institute for Health and Care Excellence (NICE) and the European Society of Cardiology (ESC) recommendations.
Methods
A random sampling of the HFrEF cohort discharged from the cardiac unit at our institution following HF-related hospitalisation was performed across four distinct time points matched with respective interventions. Three iterative cycles (baseline analysis and two educational interventions – departmental teaching and dissemination of innovative mnemonics sheets – THE WET TO DRY [Figure 1]) were completed using Plan-Do-Study-Act (PDSA) methodology. The quality of patients DS was objectively analysed based on the inclusion of physiological and investigation parameters, in-patient treatment, initiation/titration of GDMT, F/U care coordination, and patient education.
Results
Sixty-six patients, mean±SD age 74.6±12.8y were enrolled between 2018–2021. The baseline reporting of presenting complaints, trigger and investigation findings were high and consistent throughout all cycles. A positive trend was observed in the reporting of physiological parameters and in-patient treatment post-interventions. Patient education and vaccines offered remained low despite improving compliance. As such, a consensus on the provision of nurse-led pre-discharge review label and interactive patient personal passport (Figure 1) was achieved via a group of cardiologists and HF specialist nurses to address identified practice gap from preceding PDSA cycles. Full adherence to GDMT and the inclusion of F/U pathway were observed following the provision of nurse-led review label (Figure 2).
Conclusion
This study demonstrates that educational interventions – departmental teaching and innovative mnemonics can be effective in improving the quality of HF DS. Structured nurse-led review label and interactive patient personal passport are feasible interventions, which can be implemented at minimal cost to sustain adherence to GDMT, F/U care coordination and individualised patient education.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- C Hey
- James Paget Hospitals, Department of Cardiology, Norfolk, United Kingdom
| | - S Zahoor
- James Paget Hospitals, Department of Cardiology, Norfolk, United Kingdom
| | - J Shreeve
- James Paget Hospitals, Department of Cardiology, Norfolk, United Kingdom
| | - L Gomes
- James Paget Hospitals, Department of Cardiology, Norfolk, United Kingdom
| | - S Varghese
- James Paget Hospitals, Department of Cardiology, Norfolk, United Kingdom
| | - T Alam
- Norfolk and Norwich University Hospital Foundation Trust, Department of Cardiology, Norfolk, United Kingdom
| | - J Zaman
- West Suffolk Hospital, Department of Cardiology, Bury St Edmunds, United Kingdom
| | - S Nair
- Norfolk and Norwich University Hospital Foundation Trust, Department of Cardiology, Norfolk, United Kingdom
| |
Collapse
|
28
|
Menon N, Patil V, Noronha V, Joshi A, Mathrudev V, Bhattacharjee A, Chandrasekharan A, Srinivas S, Vallathol D, Chaturvedi P, Chaukar D, Pai P, Nair S, Thiagrajan S, Ghosh Laskar S, Nawale K, Dhumal S, Tambe R, Banavali S, Prabhash K. 865MO RMAC study: A randomized study evaluating the efficacy of metronomic adjuvant chemotherapy in patients with recurrent head and neck cancers post salvage surgery, not eligible for re-irradiation. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1275] [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: 12/01/2022] Open
|
29
|
Pataia V, Nair S, Wolska M, Linara-Demakakou E, Shah T, Macklon N, Ahuja K. P–136 Factors predicting clinical outcomes of 511 recipients of vitrified oocyte donation from an UK-regulated egg bank. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Do established donor and recipient clinical markers predict recipient clinical pregnancy and live birth rates (LBRs) in a vitrified oocyte donation programme?
Summary answer
Recipient BMI and previous miscarriages predicted cumulative LBR. Likelihood of clinical pregnancy and LBR was higher in recipients of donors aged 23–29 than donors 18–22.
What is known already
The influence of age on ovarian reserve underlies the upper limit of 35 years for UK donors. However, recent evidence suggests that oocyte aneuploidy rates follow an inverse U-shaped curve in relation to a woman’s age. Conflicting evidence exists regarding the impact of other donor-related factors including BMI, AMH, oocyte yield and prior reproductive history on recipient outcomes. Moreover, the effect of recipient age, BMI, and reproductive history on oocyte donation outcome remains unclear.
Study design, size, duration
Retrospective cohort study of 325 altruistic oocyte donors matched to a total of 511 recipients. Only first donations taking place between January 2017 and December 2019 were included.
Participants/materials, setting, methods
All oocyte donors were altruistic volunteers aged 18–35 with no prior infertility diagnosis. Donor and recipient screening for suitability and safety was carried out according to the Human Fertilisation Embryology Authority guidelines. Backward stepwise logistic regression was used to identify donor, recipient and embryology parameters predictive of recipient primary outcomes defined as clinical pregnancy and live birth, either cumulative or after the first embryo transfer (ET).
Main results and the role of chance
A total of 705 fresh and frozen/thawed ETs were performed, of which 76% were elective single embryo transfers (eSETs) of blastocysts (96.5%), resulting in a cumulative clinical pregnancy and LBR of 83.5% and 70.5% respectively after 3 ETs. Recipient BMI and previous miscarriages were predictors of cumulative LBR (p < 0.05). The ratio of transferrable embryos per oocytes received/fertilised and the number of ETs needed to achieve the intended primary outcome were predictors of cumulative clinical pregnancy and LBR (p < 0.05). Donor age 18–22 was associated with lower incidence of recipient clinical pregnancy and live birth after the first ET, as compared to donor age 23–29 (p < 0.05).
Limitations, reasons for caution
The present study included only healthy oocyte donors, thus conclusions may not apply to subfertile or less healthy women. Male factors were not accounted for.
Wider implications of the findings: We demonstrate the efficacy of vitrified oocyte donation treatment and identify recipient BMI, previous miscarriages and embryology parameters as predictors of cumulative LBR. Additionally, the choice of donors aged 18–22 instead of older donors is found not to be advantageous for increasing the chance of clinical pregnancy and live birth.
Trial registration number
Not applicable
Collapse
Affiliation(s)
- V Pataia
- London Egg Bank, London Egg Bank, London, United Kingdom
| | - S Nair
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
| | - M Wolska
- London Egg Bank, London Egg Bank, London, United Kingdom
| | | | - T Shah
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
| | - N Macklon
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
| | - K Ahuja
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
| |
Collapse
|
30
|
Apsangikar P, Ghadge P, Naik M, Nair S, Payghan R. Randomised, Double-blind, Comparative Clinical Study of New Ranibizumab Biosimilar in Neovascular (Wet) Age-Related Macular Degeneration. Clin Ophthalmol 2021; 15:3087-3095. [PMID: 34295147 PMCID: PMC8291850 DOI: 10.2147/opth.s307746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/25/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The study was undertaken for regulatory purposes to establish clinical biosimilarity and interchangeability of a ranibizumab biosimilar with reference product. Patients and Methods A total of 159 subjects with neovascular (wet) age-related macular degeneration (AMD) were dosed with ranibizumab. Initial double blind period of 16 weeks was followed by open-label phase till week 24. Efficacy assessment was performed at weeks 1, 4, 8, 12, 16, 20 and 24 based on best corrected visual acuity. Change in central macular thickness was assessed by optical coherence tomography from baseline to week 24. Immunogenicity assessment was done in both arms at baseline, week 16 and week 24. Safety evaluation included clinical and ophthalmic examination, adverse events, vital signs, laboratory parameters and immunogenicity in both treatment arms. Results In the biosimilar test arm, 104 (98.11%) and 105 (99.06%) patients lost fewer than 15 letters in visual acuity at week 16 and week 24, respectively, compared with 53 (100%) at both follow-ups in reference arm. In the test arm, 27 (25.47%) and 34 (32.08%) patients gained at least 15 letters in visual acuity till week 16 and week 24 respectively, compared with 17 (32.08%) and 23 (43.30%) in the reference arm. In the test arm, mean change in central macular thickness at 24 weeks was −89.93 µm against −64.42 µm in the reference arm. Difference was statistically not significant for any endpoint at 16 and 24 weeks for the primary and secondary endpoints. Conclusion The evaluation of efficacy, safety and immunogenicity was concluded to show no meaningful clinical difference for biosimilar ranibizumab with the reference product.
Collapse
Affiliation(s)
| | | | - Manoj Naik
- Reliance Life Sciences Pvt. Ltd, Mumbai, India
| | | | | |
Collapse
|
31
|
Affiliation(s)
- S Nair
- St Vincent's University Hospital, Dublin, Ireland
| | - H Gallagher
- St Vincent's University Hospital, Dublin, Ireland
| | - N Conlon
- St Vincent's University Hospital, Dublin, Ireland
| |
Collapse
|
32
|
Gan CL, Yang Z, Salahia G, Halpin S, Nair S. A single-centre experience and literature review of Flow Re-Directional Endoluminal Device (FRED) in endovascular treatment of intracranial aneurysms. Clin Radiol 2020; 76:238.e1-238.e8. [PMID: 33317786 DOI: 10.1016/j.crad.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
AIM To present initial single-centre experience with the Flow Re-Direction Endoluminal Device, FRED. MATERIALS AND METHODS This was a retrospective study. All patients treated with FRED from October 2015 to April 2017 were included in the study. Details of the aneurysms, complications as well as follow-up results were recorded. A PubMed search was performed using the keywords "Flow Re-Direction Endoluminal Device", "FRED", "flow diverter", "FD", "FD Stent", "flow re-direction" and "flow redirection" and the results were reviewed and compared to the present authors. RESULTS A total of 21 patients with 25 aneurysms were analysed. No patient was lost to follow-up. At 6 months follow-up, 17 aneurysms (68%) were completely occluded, five had reduced flow, two had persistent flow and the remaining one showed increased flow. Two aneurysms from the reduced flow at 6 months had achieved complete occlusion at 1 year, raising the complete occlusion rate to 76%. Overall, 22/25 (88%) aneurysms were either occluded completely or had reduced flow at 1 year. The appearances of the other aneurysms were stable in subsequent follow-ups. Three complications were recorded (one haemorrhagic, two occlusive/thromboembolic). There was no mortality in the present study. The occlusion rate at University Hospital of Wales as well as the complication rate was comparable to other centres on published data. CONCLUSION FRED is a safe and effective flow diverter, which can be used to treat complex aneurysms that would have been of higher risk and for which for conventional coiling would be ineffective or unsuitable.
Collapse
Affiliation(s)
- C L Gan
- Neuroradiology Department, University Hospital of Wales, Cardiff, UK; Directorate Neurosciences, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
| | - Z Yang
- Neuroradiology Department, University Hospital of Wales, Cardiff, UK
| | - G Salahia
- Neuroradiology Department, University Hospital of Wales, Cardiff, UK
| | - S Halpin
- Neuroradiology Department, University Hospital of Wales, Cardiff, UK; Radiology Department, Royal Glamorgan Hospital, Llantrisant, UK
| | - S Nair
- Neuroradiology Department, University Hospital of Wales, Cardiff, UK; Neuroradiology Department, Queen's Medical Centre, Nottingham, UK
| |
Collapse
|
33
|
Apsangikar P, Ghadge P, Naik M, Nair S. Randomized Comparative Clinical Study of First Global Omalizumab Biosimilar with Innovator Product in Moderate to Severe Persistent Asthma. J Assoc Physicians India 2020; 68:61-65. [PMID: 33247645] [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: 06/12/2023]
Abstract
PURPOSE OF STUDY Omalizumab the first anti-IgE antibody is proven with several real-world studies and meta-analyses as important adjuvant in severe allergic asthma. This study was undertaken for the first omalizumab biosimilar to establish clinical biosimilarity and interchangeability with originator product. MATERIALS AND METHODS In this randomized, double-blind comparative study 105 subjects (70 subjects in the study group and 35 subjects in the reference group) were dosed up to week 16 as double blind phase and responders entered open label phase till week 24. All responders at week 16 received study product in open-label phase of the study as per their dosing schedule till week 24. The additional efficacy assessment visit was performed till week 24. Safety follow up visit was performed in responders at week 26. The pharmacokinetic (PK) and pharmacodynamic (PD) assessment was planned in 48 subjects after first dose of omalizumab. RESULTS In double blind phase, 4 (5.80%) asthma exacerbations were reported in study arm compared to 1 (2.86%) asthma exacerbation in reference arm with no statistically significant difference (p>0.05). The time to first asthma exacerbation was 53 days in study arm compared to 62 days in reference arm. In study and reference arm, the mean change from baseline in forced expiratory volume in one second (FEV1%) was 7.51 and 5.98 at week 4; and 12.30 and 8.94 at week 16 respectively while mean change from baseline in forced expiratory volume in one second/forced vital capacity (FEV1/FVC%) was 4.20 and 4.06 at week 4 and 6.77 and 7.10 at week 16 respectively (no statistically significant difference, p>0.05). At week 16, 4 (5.80%) subjects in study arm had 50-75% inhaled corticosteroids (ICS) dose reduction compared to 2 (5.71%) subjects in reference arm. The proportion of subjects with meaningful improvement in Asthma Quality of Life Questionnaire (AQLQ) (improvement in overall AQLQ score ≥0.5), mean change in overall Asthma Control Questionnaire (ACQ) score and proportion of responders based on Global evaluation of treatment effectiveness (GETE) assessment also was similar at 16 weeks. A total of 101 adverse events were reported out of which 63 were reported in the study or biosimilar arm and 38 were reported in the reference or innovator arm. Two serious adverse events (SAEs) were reported, one in each arm. No deaths occurred during this study and the safety observations are consistent with the known safety profile of omalizumab. All the samples analysed in this study were negative for anti-omalizumab antibodies. There was no significant difference in the PK and PD evaluation. CONCLUSION The evaluation of pharmacokinetics, pharmacodynamics, efficacy, safety and immunogenicity was concluded to show no meaningful clinical difference of the biosimilar omalizumab with the reference product.
Collapse
Affiliation(s)
- Prasad Apsangikar
- Head Medical Affairs, Reliance Life Sciences Pvt. Ltd., Mumbai, Maharashtra
| | - Pravin Ghadge
- Head Clinical Research, Reliance Life Sciences Pvt. Ltd., Mumbai, Maharashtra
| | - Manoj Naik
- Head Pharmacovigilance, Reliance Life Sciences Pvt. Ltd., Mumbai, Maharashtra
| | - Santosh Nair
- Divisional Medical Head, Reliance Life Sciences Pvt. Ltd., Mumbai, Maharashtra
| |
Collapse
|
34
|
Blayney DW, Zhang Q, Feng J, Zhao Y, Bondarenko I, Vynnychenko I, Kovalenko N, Nair S, Ibrahim E, Udovista DP, Mohanlal R, Ogenstad S, Ette E, Du L, Huang L, Shi YK. Efficacy of Plinabulin vs Pegfilgrastim for Prevention of Chemotherapy-Induced Neutropenia in Adults With Non-Small Cell Lung Cancer: A Phase 2 Randomized Clinical Trial. JAMA Oncol 2020; 6:e204429. [PMID: 32970104 DOI: 10.1001/jamaoncol.2020.4429] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Plinabulin is a novel, non-granulocyte colony-stimulating factor (GCSF) small molecule with both anticancer and neutropenia-prevention effects. Objective To assess the efficacy and safety of plinabulin compared with pegfilgrastim for the prevention of chemotherapy-induced neutropenia following docetaxel chemotherapy in patients with non-small lung cancer. Design, Setting, and Participants This was a randomized, open-label, phase 2 clinical trial of 4 treatment arms that was conducted in 19 cancer treatment centers in the United States, China, Russia, and Ukraine. Participants were adult patients with non-small cell lung cancer whose cancer had progressed after platinum-based chemotherapy. Data were collected from April 2017 through March 2018 and analyzed from August 2019 through February 2020. Interventions All patients received docetaxel 75 mg/m2 on day 1 and were randomly assigned to 1 of 3 doses of plinabulin (5, 10, or 20 mg/m2) on day 1 or to pegfilgrastim 6 mg on day 2. Patients were treated every 21 days for 4 chemotherapy cycles. Main Outcomes and Measures The primary end point was the determination of the recommended phase 3 dose of plinabulin based on the days of severe neutropenia during chemotherapy cycle 1. Daily complete blood cell counts and absolute neutrophil counts were drawn during times of anticipated neutropenia during cycle 1. Results Of the 55 patients randomized and evaluated, the mean (SD) age was 61.3 (10.2) years, and 38 (69.1%) were men. With each escalation of the plinabulin dose, the incidence of any grade of neutropenia decreased. There were no significant differences in mean (SD) days of severe neutropenia among those treated with pegfilgrastim (0.15 [0.38] days) when dosed at day 2 vs plinabulin 20 mg/m2 (0.36 [0.93] days; P = .76) when dosed at day 1, and no safety signals were detected. Conclusions and Relevance Single dose-per-cycle plinabulin has a similar neutropenia protection benefit as pegfilgrastim. Plinabulin 40 mg fixed dose, which is pharmacologically equivalent to 20 mg/m2, will be compared with pegfilgrastim 6 mg in the phase 3 portion of this trial. Noninferior days of severe neutropenia will be the primary end point, and bone pain reduction, thrombocytopenia reduction, and quality of life maintenance will be secondary end points. Trial Registration ClinicalTrials.gov Identifier: NCT03102606.
Collapse
Affiliation(s)
| | - Qingyuan Zhang
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Jifeng Feng
- Department of Medical Oncology, Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China
| | - Yanqiu Zhao
- Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Igor Bondarenko
- Dnipropetrovsk Medical Academy, Ukraine. Dnepropetrovsk, Ukraine
| | - Ihor Vynnychenko
- Sumy Regional Clinical Oncology Dispensary, Sumy State University, Sumy, Ukraine
| | | | - Santosh Nair
- Mid Florida Hematology and Oncology Center, Orange City
| | - Emad Ibrahim
- Redlands Community Hospital, Redlands, California
| | | | | | | | - Ene Ette
- Anoixis Corporation, Natick, Massachusetts
| | - Lihua Du
- Wanchun Bulin Pharmaceuticals Limited, Dalian, China
| | - Lan Huang
- BeyondSpring Pharmaceuticals, New York, New York
| | - Yuan-Kai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| |
Collapse
|
35
|
Dhillon PS, Pointon K, Lenthall R, Nair S, Subramanian G, McConachie N, Izzath W. Regional Mechanical Thrombectomy Imaging Protocol in Patients Presenting with Acute Ischemic Stroke during the COVID-19 Pandemic. AJNR Am J Neuroradiol 2020; 41:1849-1855. [PMID: 32819897 PMCID: PMC7661079 DOI: 10.3174/ajnr.a6754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Chest CT is a rapid, useful additional screening tool for coronavirus disease 2019 (COVID-19) in emergent procedures. We describe the feasibility and interim outcome of implementing a modified imaging algorithm for COVID-19 risk stratification across a regional network of primary stroke centers in the work-up of acute ischemic stroke referrals for time-critical mechanical thrombectomy. MATERIALS AND METHODS We undertook a retrospective review of 49 patients referred to the regional neuroscience unit for consideration of mechanical thrombectomy between April 14, 2020, and May 21, 2020. During this time, all referring units followed a standard imaging protocol that included a chest CT in addition to a head CT and CT angiogram to identify Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infective pulmonary changes. RESULTS Overall, 2 patients had typical COVID-19 radiologic features and tested positive, while 7 patients had indeterminate imaging findings and tested negative. The others had normal or atypical changes and were not diagnosed with or suspected of having COVID-19. There was an overall sensitivity of 100%, specificity of 74.1%, negative predictive value of 100%, and positive predictive value of 22.2% when using chest CT to diagnose COVID-19 in comparison with the real-time reverse transcriptase-polymerase chain reaction test. The mean additional time and radiation dose incurred for the chest CT were 184 ± 65.5 seconds and 2.47 ± 1.03 mSv. Multiple cardiovascular and pulmonary incidental findings of clinical relevance were identified in our patient population. CONCLUSIONS Chest CT provides a pragmatic, rapid additional tool for COVID-19 risk stratification among patients referred for mechanical thrombectomy. Its inclusion in a standardized regional stroke imaging protocol has enabled efficient use of hospital resources with minimal compromise or delay to the overall patient treatment schedule.
Collapse
Affiliation(s)
- P S Dhillon
- From the Interventional Neuroradiology Department (P.S.D., R.L., S.N., N.M., W.I.), Queen's Medical Centre, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - K Pointon
- Cardiothoracic Radiology Department (K.P.)
| | - R Lenthall
- From the Interventional Neuroradiology Department (P.S.D., R.L., S.N., N.M., W.I.), Queen's Medical Centre, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - S Nair
- From the Interventional Neuroradiology Department (P.S.D., R.L., S.N., N.M., W.I.), Queen's Medical Centre, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - G Subramanian
- Stroke Medicine Department (G.S.), Nottingham City Hospital, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - N McConachie
- From the Interventional Neuroradiology Department (P.S.D., R.L., S.N., N.M., W.I.), Queen's Medical Centre, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - W Izzath
- From the Interventional Neuroradiology Department (P.S.D., R.L., S.N., N.M., W.I.), Queen's Medical Centre, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| |
Collapse
|
36
|
Denlinger C, Lu G, Nair S, Kalinka E, Hosein F, Li J, Khushalani N. 1155TiP Pan-tumour study CheckMate 8TT for long-term follow-up of cancer survivors who have participated in trials investigating nivolumab. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
37
|
Kato Y, Liew BS, Sufianov AA, Rasulic L, Arnautovic KI, Dong VH, Florian IS, Olldashi F, Makhambetov Y, Isam B, Thu M, Enkhbayar T, Kumarasinghe N, Bajamal AH, Nair S, Sharif S, Sharma MR, Landeiro JA, Yampolsky CG, El-Ghandour NMF, Hossain AM, Sim S, Chemate S, Burhan H, Feng L, Andrade H, Germano IM. Correction to: Review of global neurosurgery education: Horizon of Neurosurgery in the Developing Countries. Chin Neurosurg J 2020; 6:30. [PMID: 32925985 PMCID: PMC7444201 DOI: 10.1186/s41016-020-00209-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s41016-020-00194-1.].
Collapse
Affiliation(s)
- Y. Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - B. S. Liew
- Department of Neurosurgery, Hospital Sungai Buloh, Sungai Buloh, Selangor Malaysia
| | - A. A. Sufianov
- Federal State-Financed Institution “Federal Centre of Neurosurgery” of Ministry of Health of the Russian Federation, Tyumen, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - L. Rasulic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - K. I. Arnautovic
- Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennessee, Memphis, TN USA
| | - V. H. Dong
- Neurosurgery Center of Viet Duc University Hospital, Hanoi, Vietnam
| | - I. S. Florian
- Department of Neurosurgery, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Cluj County Romania
| | - F. Olldashi
- Department of Neurosurgery, University Hospital of Trauma, Tirana, Albania
| | | | - B. Isam
- Federal State-Financed Institution “Federal Centre of Neurosurgery” of Ministry of Health of the Russian Federation, Tyumen, Russia
| | - M. Thu
- Neurosurgical Centre, Yangon General Hospital, Yangoon, Myanmar
| | - Ts. Enkhbayar
- Mongolian Neurosurgical Society, Ulaabaatar, Mongolia
| | | | - A. H. Bajamal
- Department of Neurosurgery, Dr. Soetomo General Hospital, Airlangga University, Surabaya, Indonesia
| | - S. Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - S. Sharif
- Institute of Postgraduate Studies and Medical Sciences, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - M. R. Sharma
- Department of Neurosurgery, TU Teaching Hospital, Kathmandu, Nepal
| | - J. A. Landeiro
- Department of Neurosurgery, Universidade Federal Fluminense, Niterói, Brazil
| | - C. G. Yampolsky
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - N. M. F. El-Ghandour
- Department of Neurosurgery, Faculty of Medicine, Cairo University, 81 Nasr Road, Nasr City, Cairo Egypt
| | - A. M. Hossain
- Bangladesh Society of Neurosurgeons, Dhaka, Bangladesh
| | - S. Sim
- Khema Clinic, 18 Street, Phnom Penh, 528 Cambodia
| | - S. Chemate
- DNB Neurosurgery, Apollo Hospital, Chennai, India
| | - Hira Burhan
- Institute of Neurosciences, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - L. Feng
- China International Neuroscience Institute, Beijing, China
| | - H. Andrade
- Henan Provincial People’s Hospital, Juha Hernesniemi International Center for Neurosurgery, University of Zhengzhou, Zhengzhou, China
| | | |
Collapse
|
38
|
Lundon DJ, Kelly BD, Nair S, Bolton DM, Kyprianou N, Wiklund P, Tewari A. Early mortality risk stratification after SARS-CoV-2 infection. Med Intensiva 2020; 45:S0210-5691(20)30219-9. [PMID: 32912654 PMCID: PMC7334967 DOI: 10.1016/j.medin.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022]
Affiliation(s)
- D J Lundon
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
| | - B D Kelly
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - S Nair
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - D M Bolton
- Department of Urology, University of Melbourne, Austin Health, Melbourne, United States
| | - N Kyprianou
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - P Wiklund
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States
| | - A Tewari
- Department of Urology, Icahn School of Medicine, Mount Sinai Hospitals, New York, United States.
| |
Collapse
|
39
|
Treacy P, Martini A, Falagario U, Ratnani P, Horowitz A, Wajswol E, Begemann D, Beksac A, Durand M, Wiklund P, Nair S, Kyprianou N, Tewari A. The role of connective tissue in prostate cancer growth and progression. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
40
|
Liu AY, Dower A, Nair S. Dexmedetomidine infusion for sedation in a patient with myotonic dystrophy. Anaesth Rep 2020; 8:135-137. [PMID: 33210091 DOI: 10.1002/anr3.12070] [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] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
Myotonic dystrophy type 1 is the most common muscular dystrophy in adults. Anaesthetic management should take into consideration the numerous body systems affected, including the musculoskeletal; respiratory; cardiovascular; gastro-intestinal; and central nervous systems. A 42-year-old man with myotonic dystrophy presented for septoplasty and bilateral inferior turbinate reductions. He had severe upper and lower extremity myotonia and weakness, pulmonary impairment with non-obstructive patterns and first-degree atrioventricular block with reduced ejection fraction. He used bilevel positive airway pressure, a cough assist device and was paced 3% of the time with a single-chamber pacemaker. To reduce potential complications associated with opioid use and general anaesthetics, an opioid-free technique was planned using local anaesthetic infiltration and sedation with a dexmedetomidine infusion. The patient maintained spontaneous ventilation and haemodynamic stability, and had an uneventful postoperative course. Dexmedetomidine is a highly selective α2-adrenergic receptor agonist that has the ability to provide sedation, analgesia and anxiolysis with a stable haemodynamic profile. Avoiding both opioids and general anaesthetics in these patients may decrease the risk of peri-operative complications.
Collapse
Affiliation(s)
- A Y Liu
- Michael G. DeGroote School of Medicine Hamilton Canada
| | - A Dower
- Department of Anesthesiology McMaster University and Hamilton Health Sciences Hamilton Canada
| | - S Nair
- Department of Anesthesiology McMaster University and Hamilton Health Sciences Hamilton Canada
| |
Collapse
|
41
|
Kato Y, Liew BS, Sufianov AA, Rasulic L, Arnautovic KI, Dong VH, Florian IS, Olldashi F, Makhambetov Y, Isam B, Thu M, Enkhbayar T, Kumarasinghe N, Bajamal AH, Nair S, Sharif S, Sharma MR, Landeiro JA, Yampolsky CG, El-Ghandour NMF, Hossain AM, Sim S, Chemate S, Burhan H, Feng L, Andrade H, Germano IM. Review of global neurosurgery education: Horizon of Neurosurgery in the Developing Countries. Chin Neurosurg J 2020; 6:19. [PMID: 32922948 PMCID: PMC7398343 DOI: 10.1186/s41016-020-00194-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/13/2020] [Indexed: 01/19/2023] Open
Abstract
Globally, the discipline of neurosurgery has evolved remarkably fast. Despite being one of the latest medical specialties, which appeared only around hundred years ago, it has witnessed innovations in the aspects of diagnostics methods, macro and micro surgical techniques, and treatment modalities. Unfortunately, this development is not evenly distributed between developed and developing countries. The same is the case with neurosurgical education and training, which developed from only traditional apprentice programs in the past to more structured, competence-based programs with various teaching methods being utilized, in recent times. A similar gap can be observed between developed and developing counties when it comes to neurosurgical education. Fortunately, most of the scholars working in this field do understand the coherent relationship between neurosurgical education and neurosurgical practice. In context to this understanding, a symposium was organized during the World Federation of Neurological Surgeons (WFNS) Special World Congress Beijing 2019. This symposium was the brain child of Prof. Yoko Kato—one of the eminent leaders in neurosurgery and an inspiration for female neurosurgeons. Invited speakers from different continents presented the stages of development of neurosurgical education in their respective countries. This paper summarizes the outcome of these presentations, with particular emphasis on and the challenges faced by developing countries in terms of neurosurgical education and strategies to cope with these challenges.
Collapse
Affiliation(s)
- Y Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - B S Liew
- Department of Neurosurgery, Hospital Sungai Buloh, Sungai Buloh, Selangor Malaysia
| | - A A Sufianov
- Federal State-Financed Institution "Federal Centre of Neurosurgery" of Ministry of Health of the Russian Federation, Tyumen, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - L Rasulic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - K I Arnautovic
- Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennessee, Memphis, TN USA
| | - V H Dong
- Neurosurgery Center of Viet Duc university hospital, Hanoi, Vietnam
| | - I S Florian
- Department of Neurosurgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Cluj County Romania
| | - F Olldashi
- Department of Neurosurgery, University Hospital of Trauma, Tirana, Albania
| | | | - B Isam
- Federal State-Financed Institution "Federal Centre of Neurosurgery" of Ministry of Health of the Russian Federation, Tyumen, Russia
| | - M Thu
- Neurosurgical Centre, Yangon General Hospital, Yangoon, Myanmar
| | - Ts Enkhbayar
- Mongolian Neurosurgical Society, Ulaabaatar, Mongolia
| | | | - A H Bajamal
- Department of Neurosurgery, Dr Soetomo General Hospital, Airlangga University, Surabaya, Indonesia
| | - S Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - S Sharif
- Institute of Postgraduate Studies and Medical Sciences, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - M R Sharma
- Department of Neurosurgery, TU Teaching Hospital, Kathmandu, Nepal
| | - J A Landeiro
- Department of Neurosurgery, Universidade Federal Fluminense, Niterói, Brazil
| | - C G Yampolsky
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - N M F El-Ghandour
- Department of Neurosurgery, Faculty of Medicine, Cairo University, 81 Nasr Road, Nasr City, Cairo, Egypt
| | - A M Hossain
- Bangladesh Society of Neurosurgeons, Dhaka, Bangladesh
| | - S Sim
- Khema Clinic, 18 Street, Phnom Penh, 528 Cambodia
| | - S Chemate
- DNB Neurosurgery, Apollo Hospital, Chennai, India
| | - Hira Burhan
- Institute of Neurosciences, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - L Feng
- China International Neuroscience Institute, Beijing, China
| | - H Andrade
- Department of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | | |
Collapse
|
42
|
Gensler LS, Chakravarty SD, Cameron C, Peterson S, Spin P, Kafka S, Nair S, Deodhar A. Propensity score matching/reweighting analysis comparing intravenous golimumab to infliximab for ankylosing spondylitis using data from the GO-ALIVE and ASSERT trials. Clin Rheumatol 2020; 39:2907-2917. [PMID: 32367407 PMCID: PMC7497341 DOI: 10.1007/s10067-020-05051-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 12/17/2022]
Abstract
Objective To compare the relative efficacy of intravenous golimumab (GOL IV) and infliximab (IFX) for active ankylosing spondylitis (AS). Methods Propensity score (PS) methods were used to compare the efficacy of GOL IV 2 mg/kg and IFX 5 mg/kg using individual patient data (IPD) from the active arms of the phase 3 GO-ALIVE and ASSERT studies. Outcomes included the proportion of patients with a ≥ 20% improvement in the Assessment of Spondyloarthritis International Society Criteria (ASAS20), change from baseline in Bath Ankylosing Spondylitis Functional Index (BASFI) score, and change from baseline in C-reactive protein (CRP) levels from weeks 4–52. Results Before matching, 105 patients were treated with GOL IV and 201 patients were treated with IFX. After matching on all covariates, 118 patients were included in the ASAS20 analysis, 96 in the BASFI analysis, and 160 in the CRP analysis. After matching, GOL IV showed significantly greater improvement in ASAS20 response than IFX for weeks 28–44 (e.g., OR = 9.05 [95% CI 1.62–50.4] at week 44) and was comparable in change from baseline in BASFI scores and CRP levels to IFX at all time points. Results were robust for inclusion of different sets of covariates in scenario analyses. Conclusions This is the first analysis of its kind to leverage clinical trial data to compare two biologics using PS methods in the treatment of active AS. Overall, GOL IV was associated with greater improvement in ASAS20 response than IFX in patients with AS at 28, 36, and 44 weeks of follow-up.Key Points • Although intravenous golimumab (GOL IV) and infliximab (IFX) are the only two IV-based tumor necrosis factor (TNF) inhibitors with demonstrated phase 3 clinical efficacy in patients with ankylosing spondylitis (AS), no study has evaluated their comparative efficacy in a head-to-head trial. • Propensity score matching was used to derive indirect treatment comparisons of GOL IV and IFX for ≥ 20% in the Assessment of Spondyloarthritis International Society Criteria (ASAS20), change in Bath Ankylosing Spondylitis Functional Index (BASFI), and change in C-reactive protein (CRP) using individual patient data from the GO-ALIVE and ASSERT phase 3 trials. • Propensity score matched indirect comparisons showed improved relative efficacy of GOL IV compared to IFX; after matching for up to 16 baseline covariates, GOL IV was associated with significantly greater odds of ASAS20 response at weeks 28, 36, and 44 than IFX as well as equivalent changes from baseline in BASFI and CRP. • This novel application of propensity score matching using data from phase 3 trials, the first analysis of its kind in AS, allowed adjustment for important imbalances in prognostic factors between trials to generate estimates of comparative efficacy between GOL IV and IFX in the absence of a head-to-head trial between these treatments. |
Electronic supplementary material The online version of this article (10.1007/s10067-020-05051-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- L S Gensler
- Department of Medicine/Rheumatology, University of California, San Francisco, 400 Parnassus Ave, Box 0326, San Francisco, CA, 94143-0326, USA.
| | - S D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Chris Cameron
- EVERSANA™, Burlington, Ontario, Canada. .,EVERSANA™, 275 Charlotte St. Suite 207, Sydney, Nova Scotia, B1P 1C6, Canada.
| | - S Peterson
- Janssen Global Services, LLC, Horsham, PA, USA
| | - P Spin
- EVERSANA™, Burlington, Ontario, Canada
| | - S Kafka
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - S Nair
- Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - A Deodhar
- Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
43
|
Singh S, Khorsandi M, De S, Dalzell J, Morcos K, Hegazy Y, Al-Haideri H, Nair S, Doshi H, Al-Attar N, Curry P. Mitigating Risks of Primary Graft Dysfunction with Antegrade Myocardial Perfusion. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.880] [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
|
44
|
Anandh U, Gopal B, Conjeevaram A, Cortes C, Gleeson S, Madariaga H, Malina M, Arce-Amare F, Lerma E, Turgut D, Bek S, Nair S, Paunic Z, Desai T, Pastor A. SAT-484 Trends in Twitter Coverage of Nephrology Conferences through Novel Indices of Impact. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.516] [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: 10/24/2022] Open
|
45
|
Aruljothy A, Russell L, Nair S, Albashir S. A185 ABDOMINAL WALL VARICES: A CASE REPORT. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Portal hypertension in cirrhosis results in variable and numerous portosystemic collateral circulations. Computed tomography (CT) and Doppler ultrasound (US) can identify these collateral vessels, especially abdominal wall varices, which can be encountered during a bedside paracentesis.
Aims
Describe a case of traumatic abdominal wall variceal bleed.
Methods
Case report.
Results
A 53 year-old Caucasian male presented to the emergency department (ED) with 4-days of abdominal pain and 2-months of increased abdominal girth. His medical history included Child Pugh Class B alcoholic liver cirrhosis diagnosed 1 year ago. No prior history of ascites, esophageal variceal bleed or hepatic encephalopathy. In the ED, his US showed moderate ascites with right portal vein flow reversal. A diagnostic RLQ paracentesis showed yellow ascitic fluid, no spontaneous bacterial peritonitis (SBP), and he was discharged home with diuretics.
He returned to the ED the next day for increased abdominal girth with a Hb of 103 g/L. A diagnostic RLQ paracentesis showed orange-red ascitic fluid and no SBP. The following day, a therapeutic US-guided paracentesis was attempted in the RLQ and left-lower quadrant LLQ; however, ascitic fluid aspirate was grossly bloody. The procedure was aborted. Hb was 82 g/L and progressively decreased. CT angiogram was performed and showed a 10.7 x 4.7 x 8.0 cm hyperdense fluid in the right paracolic gutter near the paracentesis site, consistent with intraperitoneal hemorrhage (Figure A). The insertion site was seen as abdominal wall musculature focal thickening around abdominal wall varices and no contrast extravasation was seen. Gastroesophageal, splenic hilar and omental varices were seen. Doppler US showed no sonographic signs of active extravasation. Interventional Radiology performed a US-guided paracentesis and aspirated 3650 mL of hemorrhagic fluid. Color Doppler US showed small varices within the subcutaneous soft tissues (Figure A).
The patient later developed hematemesis with an EGD showing a large high-risk esophageal varix actively bleeding that was banded. Given the refractory variceal bleeding, a Minnesota tube was inserted 4 days later and a transjugular intrahepatic portosystemic shunt was inserted the following day. Unfortunately, the patient developed progressive worsening hepatic encephalopy, multi-organ failure and expired 7-days later.
Conclusions
Adjunct imaging modalities such as color flow Doppler US or CT can be used as a screening tool to identify abdominal wall varices and reduce paracentesis bleeding complications.
Funding Agencies
None
Collapse
Affiliation(s)
| | - L Russell
- Gastroenterology, McMaster Univeristy, Hamilton, ON, Canada
| | - S Nair
- McMaster University, Hamilton, ON, Canada
| | - S Albashir
- McMaster University, Hamilton, ON, Canada
| |
Collapse
|
46
|
Cosgrave D, Vencken S, Galligan M, McGuinness S, Soukhin E, McMullan V, Nair S, Puttappa A, Boylan J, Hussain R, Conlon N, Doran P, Nichol A. The effect of a low‐dose naloxone infusion on the incidence of respiratory depression after intrathecal morphine administration for major open hepatobiliary surgery: a randomised controlled trial. Anaesthesia 2019; 75:747-755. [DOI: 10.1111/anae.14931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/13/2022]
Affiliation(s)
- D. Cosgrave
- Department of Anaesthesia St. Vincent's University Hospital Dublin Ireland
| | - S. Vencken
- Clinical Research Centre University College Dublin Ireland
| | - M. Galligan
- Clinical Research Centre University College Dublin Ireland
| | - S. McGuinness
- Department of Anaesthesia St. Vincent's University Hospital Dublin Ireland
- Department of Anaesthesia the National Maternity Hospital Dublin Ireland
| | - E. Soukhin
- Department of Anaesthesia Auckland City Hospital Auckland New Zealand
| | - V. McMullan
- Department of Anaesthesia Tallaght University Hospital Dublin Ireland
| | - S. Nair
- Liver transplantation and cardiac anaesthesia Kings College Hospital NHS Trust London UK
| | - A. Puttappa
- Department of Anaesthesia Addenbrookes Hospital Cambridge University Hospital NHS Trust Cambridge UK
| | - J. Boylan
- Department of Anaesthesia St. Vincent's University Hospital Dublin Ireland
| | - R. Hussain
- Clinical Research Centre St. Vincent's University Hospital Dublin Ireland
| | - N. Conlon
- Department of Anaesthesia St. Vincent's University Hospital Dublin Ireland
| | - P. Doran
- Australian and New Zealand Intensive Care Research Centre Monash University Melbourne Vic. Australia
| | - A. Nichol
- Department of Intensive Care Medicine St. Vincent's University Hospital Dublin Ireland
- Clinical Research Centre St. Vincent's University Hospital Dublin Ireland
- Australian and New Zealand Intensive Care Research Centre Monash University Melbourne Vic. Australia
| |
Collapse
|
47
|
Treacy P, Martini A, Ratnani P, Nair S, Horowitz A, Wiklund P, Durand M, Tewari A. La signature transcriptomique des gènes du tissu conjonctif prédit des caractéristiques péjoratives chez les patients avec un cancer de prostate localisé. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.079] [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]
|
48
|
Naziri J, Savla B, Nadeem J, Adediran S, Nair S, Mcintosh A. A Retrospective Review of Unresectable Stage III and Stage IV Oligometastatic Cancers Treated with Concurrent PD-1 Inhibition and Ablative Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1235] [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]
|
49
|
White Z, Dates C, Rajbhandari R, Nair S, Nozell S, Bredel M. Impact of ANXA7 I1 Expression on PDGFRA and MET Endosomal Trafficking in Glioblastoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1009] [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]
|
50
|
Singh L, Dubey R, Singh S, Goel R, Nair S, Singh PK. Measuring quality of antenatal care: a secondary analysis of national survey data from India. BJOG 2019; 126 Suppl 4:7-13. [DOI: 10.1111/1471-0528.15825] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 11/27/2022]
Affiliation(s)
- L Singh
- ICMR – National Institute of Medical StatisticsNew Delhi India
| | - R Dubey
- ICMR – National Institute of Medical StatisticsNew Delhi India
| | - S Singh
- Division of Reproductive Biology, Maternal and Child Health Indian Council of Medical Research (ICMR) New Delhi India
| | - R Goel
- Division of Reproductive Biology, Maternal and Child Health Indian Council of Medical Research (ICMR) New Delhi India
| | - S Nair
- ICMR – National Institute of Medical StatisticsNew Delhi India
| | - PK Singh
- Division of Preventive Oncology, ICMR – National Institute of Cancer Prevention and ResearchNoida India
| |
Collapse
|