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Haq SH, Shah SR, Golzarian H, Laird A, Cole W, Patel SM. A Novel Percutaneous Snare-Assisted Manipulation and Repositioning of a ProtekDuo Cannula in a COVID-19 Acute Respiratory Distress Syndrome. Am J Cardiol 2024; 210:113-115. [PMID: 37944412 DOI: 10.1016/j.amjcard.2023.08.050] [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: 06/07/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 11/12/2023]
Abstract
Venovenous extracorporeal membrane oxygenation [VV-ECMO] has gained increasing notoriety during the COVID-19 pandemic as a salvation therapy for fulminant respiratory failure. Various configurations can present unique challenges in management. For instance, the ProtekDuo cannula is a 29Fr to 31Fr dual-lumen cannula inserted by way of the right internal jugular vein that allows for right atrium to pulmonary artery bypass with an attached oxygenator, essentially resulting in VV-ECMO. Understanding that these different configurations inevitably dictate the types of complications that can arise during the circuit implantation and management is imperative. However, in a hemodynamically unstable patient, time or resources may not permit standard maneuvers for management. In conclusion, we present an innovative, percutaneous approach which allowed the restoration of flow and oxygenation in a decompensating ProtekDuo patient without having to explant/disconnect the circuit or implant a new VV-ECMO circuit.
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Affiliation(s)
- Syed H Haq
- Department of Internal Medicine, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio
| | - Sidra R Shah
- Department of Internal Medicine, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio
| | - Hafez Golzarian
- Department of Internal Medicine, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio
| | - Amanda Laird
- Department of Critical Care Medicine, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio
| | - William Cole
- Department of Critical Care Medicine, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio
| | - Sandeep M Patel
- Structural Heart & Intervention Center, BonSecour Mercy Health-St. Rita's Medical Center, Lima, Ohio.
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Haq SH, Shah SR, Chandra J, Kannan P, Patel SM. Case Report: It's not always about the veins; intervention of bilateral May-Thurner Syndrome secondary to iliac aneurysm. Front Cardiovasc Med 2023; 10:1279981. [PMID: 38034392 PMCID: PMC10687451 DOI: 10.3389/fcvm.2023.1279981] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
May-Thurner Syndrome (MTS) remains evasive because of the insidiousness and variable etiologies by which it can manifest. In this study, we examine a unique presentation of MTS resulting from compression of both common iliac veins by a right common iliac artery aneurysm that required complex endovascular venous and arterial intervention.
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Affiliation(s)
- Syed H. Haq
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, OH, United States
| | - Sidra R. Shah
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, OH, United States
| | - Jaya Chandra
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, OH, United States
| | - Pavithra Kannan
- Department of Internal Medicine, OhioHealth Riverside, Columbus, OH, United States
| | - Sandeep M. Patel
- Structural Heart & Intervention Center, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, OH, United States
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Golzarian H, Pasley BA, Shah SR, Thiel AM, Hempfling GL, Otto M, Otto T, Patel SM. Single-operator left atrial appendage occlusion utilizing conscious sedation, transoesophageal echocardiography, lack of outpatient pre-imaging, and same-day expedited discharge: a feasibility case series. Eur Heart J Case Rep 2023; 7:ytad339. [PMID: 37559785 PMCID: PMC10409408 DOI: 10.1093/ehjcr/ytad339] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/02/2023] [Accepted: 07/19/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Contemporary procedural guidelines for percutaneous left atrial appendage occlusions (LAAO) with the WATCHMAN device often require the utilization of pre-screening imaging, general anaesthesia, intubation, a dedicated intra-procedural echocardiographer, and overnight observation. For these reasons, LAAO with the WATCHMAN is not economically feasible for many hospital systems. Thus, we sought to evaluate a newstrategy for implantation that may provide a more minimalistic and less cumbersome approach to LAAO. CASE SUMMARY We describe five cases utilizing single-operator left atrial appendage occlusion utilizing conscious sedation, transoesophageal echocardiography, lack of outpatient pre-imaging, and same-day expedited discharge (SOLO-CLOSE)-a novel single-operator procedural strategy for LAAO that safely foregoes the aforementioned procedural requirements and allows for same-day early discharge. All five patients were observed according to our newly devised SOLO-CLOSE protocol and were safely discharged home the same day. Follow-up transoesophageal echocardiography (TEE) at 45 days and 1 year revealed well-seated and well-anchored devices with no leaks (<5 mm) or device-related thrombi. DISCUSSION The SOLO-CLOSE series is the first ever documented WATCHMAN strategy that utilizes a single-operator, TEE-guided, nurse-driven conscious sedation protocol that defers pre-screening imaging and allows for same-day discharge. The versatility of this technique allows proceduralists to comfortably achieve successful LAAO despite a wide range of risk profiles. This single-operator technique has potential to become a widely accepted universal approach for non-pharmacological cardioembolic stroke prophylaxis due to its efficacy, safety, simplicity, and presumable cost-effectiveness.
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Affiliation(s)
- Hafez Golzarian
- Department of Internal Medicine, Mercy Health—St. Rita’s Medical Center, Lima, 751 West Market Street, Lima, OH 45801, USA
| | - Benjamin A Pasley
- Department of Internal Medicine, Mercy Health—St. Rita’s Medical Center, Lima, 751 West Market Street, Lima, OH 45801, USA
| | - Sidra R Shah
- Department of Internal Medicine, Mercy Health—St. Rita’s Medical Center, Lima, 751 West Market Street, Lima, OH 45801, USA
| | - Arielle M Thiel
- Structural Heart and Intervention Center, Mercy Health—St. Rita’s Medical Center, 730 West Market Street, 2K Tower, Lima, OH 45801, USA
| | - Gerri L Hempfling
- Structural Heart and Intervention Center, Mercy Health—St. Rita’s Medical Center, 730 West Market Street, 2K Tower, Lima, OH 45801, USA
| | - Michael Otto
- Structural Heart and Intervention Center, Mercy Health—St. Rita’s Medical Center, 730 West Market Street, 2K Tower, Lima, OH 45801, USA
| | - Todd Otto
- Structural Heart and Intervention Center, Mercy Health—St. Rita’s Medical Center, 730 West Market Street, 2K Tower, Lima, OH 45801, USA
| | - Sandeep M Patel
- Structural Heart and Intervention Center, Mercy Health—St. Rita’s Medical Center, 730 West Market Street, 2K Tower, Lima, OH 45801, USA
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Shah SR, Haq SH, Golzarian H, Patel SM. Endocarditis of the forgotten valve: vacuum-assisted aspiration (AngioVac) of the eustachian valve: a case report. Eur Heart J Case Rep 2023; 7:ytad222. [PMID: 37168364 PMCID: PMC10166516 DOI: 10.1093/ehjcr/ytad222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/12/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
Background Eustachian valve endocarditis (EVE) is a rare entity that traditionally has been treated with antibiotics or surgery, if refractory to antibiotic treatment. Case summary A 64-year-old man presented with right shoulder pain and new-onset hypoxia. His blood cultures were positive for methicillin-sensitive staphylococcal aureus (MSSA) 1 month ago and he was treated with antibiotics at that time. Blood cultures during this admission were again positive for MSSA. Trans-oesophageal echocardiogram showed a large independently mobile echogenic density consistent with vegetation (3.0 × 1.6 cm) on the eustachian valve (EV). The patient was a poor surgical candidate due to his multiple co-morbidities, and therefore, a non-invasive procedure called AngioVac® was selected. Discussion In the setting of infective endocarditis refractory to antibiotics, the large-bore percutaneous mechanical aspiration (AngioVac®, AngioDynamics, Latham, NY, USA) system is gaining increasing momentum as the treatment of choice over standard surgical intervention for debulking large vegetations. AngioVac® has provided a minimally invasive and effective measure especially in those unable to tolerate surgery. The novel percutaneous technique is linked to great success in right-sided endocarditis, with the tricuspid valve accounting for a majority of the cases. However, in rare instances, the EV may be involved. To our knowledge, we report the first case of EVE treated with AngioVac®.
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Affiliation(s)
- Sidra R Shah
- Department of Internal Medicine, BonSecour Mercy Health—St Rita’s Medical Center, Lima, OH, USA
| | - Syed H Haq
- Department of Internal Medicine, BonSecour Mercy Health—St Rita’s Medical Center, Lima, OH, USA
| | - Hafez Golzarian
- Department of Internal Medicine, BonSecour Mercy Health—St Rita’s Medical Center, Lima, OH, USA
| | - Sandeep M Patel
- Corresponding author. Tel: +1 419 996 5756, , Twitter: @SMPatelMD
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Haq SH, Hinegardner‐Hendricks J, Cole C, Laird A, Shah SR, Patel SM, Cole W. Catheter‐directed thrombolysis as an emergent intervention for failed vacuum thrombectomy of pulmonary embolism. Respirol Case Rep 2023; 11:e01124. [PMID: 36970297 PMCID: PMC10034618 DOI: 10.1002/rcr2.1124] [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: 01/11/2023] [Accepted: 03/04/2023] [Indexed: 03/25/2023] Open
Abstract
Acute pulmonary embolism [PE] in the setting of hemodynamic instability and right ventricular strain is a complex presentation and typically is associated with high mortality rates. Prompt recognition and early intervention are critical to the survival of these patient. In such cases, current guidelines recommend use of systemic thrombolytics, along with as needed cardiopulmonary support. If contraindications are present, mechanical thrombectomy is advised. However, guidelines poorly define the next steps in intervention if mechanical thrombectomy were to fail. We present such a scenario and the methods implored to successful remove clot burden. We add to the literature, use of catheter directed thrombolysis at a designated 2 mg/h rate as a form of emergent intervention in failed mechanical thrombectomy.
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Affiliation(s)
- Syed H. Haq
- Department of Internal MedicineBonSecour Mercy Health—St. Rita's Medical CenterLimaOhioUSA
| | | | - Cliff Cole
- Department of Internal MedicineBonSecour Mercy Health—St. Rita's Medical CenterLimaOhioUSA
| | - Amanda Laird
- Department of Critical Care MedicineBonSecour Mercy Health—St. Rita's Medical CenterLimaOhioUSA
| | - Sidra R. Shah
- Department of Internal MedicineBonSecour Mercy Health—St. Rita's Medical CenterLimaOhioUSA
| | - Sandeep M. Patel
- Structural Heart & Intervention CenterBonSecour Mercy Health—St. Rita's Medical CenterLimaOhioUSA
| | - William Cole
- Department of Critical Care MedicineBonSecour Mercy Health—St. Rita's Medical CenterLimaOhioUSA
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Haq SH, Shah SR, Bux J, Le AS, Golzarian H, Mueller D, Sreenan JJ, Patel SM, Laird A, Cole W. To intervene or not to intervene: A case of symptomatic neurocysticercosis complicated by ventriculitis. IDCases 2023; 31:e01702. [PMID: 36747911 PMCID: PMC9898726 DOI: 10.1016/j.idcr.2023.e01702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
Although well described in the current literature, Neurocysticercosis [NCC] remains an enigma when confronted by practitioners. This is in part due to the haphazard nature of the parasitic infection on the central nervous system [CNS]. These include single or multiple anatomic sites of infection, stage of parasitosis, and the resultant inflammatory response. As a result, NCC can present with a complex constellation of symptomatic presentations, making therapeutic regiments highly individualized. Despite intervention, other impediments may arise post-therapy due to the nature of the infection. We present a case of rapidly progressive symptomatic NCC that initially was successfully treated, however would eventually succumb to complications of ventriculitis.
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Affiliation(s)
- Syed H. Haq
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Sidra R. Shah
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Jannet Bux
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Anh Si Le
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Hafez Golzarian
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Daniel Mueller
- Department of Internal Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Joseph J. Sreenan
- Department of Pathology Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Sandeep M. Patel
- Department of Interventional Cardiology, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - Amanda Laird
- Department of Critical Care Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
| | - William Cole
- Department of Critical Care Medicine, BonSecour Mercy Health—St. Rita’s Medical Center, Lima, OH, USA
- Correspondence to: Department of Critical Care, St. Rita's Medical Center (Mercy), 730 West Market Street, Lima, OH 45801, USA.
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Golzarian H, Mariam A, Shah SR, Pasley BA, Haq SH, Edgerton AR, Scherger WE, Stallkamp VL, Patel D, Laird A, Cole WC, Patel SM. Amniotic fluid embolism‐induced cardiopulmonary collapse successfully treated with combination VA‐ECMO and Impella CP. ESC Heart Fail 2022; 10:1440-1444. [PMID: 36480170 PMCID: PMC10053152 DOI: 10.1002/ehf2.14254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/30/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. Prompt and aggressive resuscitative strategies are crucial in promoting survivability. We present a case of AFE resulting in cardiopulmonary collapse and subsequent cardiac arrest where we were able to safely deliver the baby and resuscitate the mother with veno-arterial extracorporeal membrane oxygenation and Impella CP-a novel combination known as ECPELLA. We discuss the implications of this approach as a more efficacious strategy in resuscitating AFE-induced cardiogenic shock and arrest.
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Affiliation(s)
- Hafez Golzarian
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Alaha Mariam
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Sidra R. Shah
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Benjamin A. Pasley
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Syed H. Haq
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Anne R. Edgerton
- Department of General Surgery BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - William E. Scherger
- Department of Obstetrics and Gynecology BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Vanessa L. Stallkamp
- Department of Obstetrics and Gynecology BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Dennis Patel
- Department of Anesthesiology BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Amanda Laird
- Department of Critical Care Services BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - William C. Cole
- Department of Critical Care Services BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Sandeep M. Patel
- Structural Heart and Intervention Center BonSecours Mercy Health—St. Rita's Medical Center 730 West Market Street, 2K Tower Lima OH 45801 USA
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8
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Golzarian H, Bux J, Mariam A, Shah SR, Pasley BA, Henneke KR, Aggarwal MB, Patel SM. Utilizing Provocative Maneuvers Intraoperatively in Conjunction With IVUS to Diagnose vTOS: The New Gold Standard. JACC Case Rep 2022; 4:950-954. [PMID: 35935158 PMCID: PMC9350895 DOI: 10.1016/j.jaccas.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
Current methodologies of diagnosing and managing venous thoracic outlet syndrome (vTOS) remain controversial, as pertinent studies using modern advancements in medicine are limited. We present a case in which we innovatively used a modified Wright's test during venography coupled with intravascular ultrasound, which allowed us to definitively determine the etiology of a vTOS. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Hafez Golzarian
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, Ohio, USA
| | - Jannet Bux
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, Ohio, USA
| | - Alaha Mariam
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, Ohio, USA
| | - Sidra R. Shah
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, Ohio, USA
| | - Benjamin A. Pasley
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, Ohio, USA
| | - Kyle R. Henneke
- Department of Internal Medicine, BonSecours Mercy Health—St. Rita’s Medical Center, Lima, Ohio, USA
| | | | - Sandeep M. Patel
- Structural Heart and Intervention Center, BonSecours Mercy Health−St. Rita’s Medical Center, Lima, Ohio, USA
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Affiliation(s)
- S B Patel
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad- 380016, India
| | - D M Shah
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad- 380016, India
| | - K G Goswami
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad- 380016, India
| | - S R Shah
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad- 380016, India
| | - P M Shah
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad- 380016, India
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Affiliation(s)
- SB Patel
- Department of Radiology, Gujarat Cancer and Research Institute, Civil Hospital Campus, Ahmedabad-16, India
| | - SR Shah
- Department of Radiology, Gujarat Cancer and Research Institute, Civil Hospital Campus, Ahmedabad-16, India
| | - KG Goswami
- Department of Radiology, Gujarat Cancer and Research Institute, Civil Hospital Campus, Ahmedabad-16, India
| | - HB Patel
- Department of Radiology, Gujarat Cancer and Research Institute, Civil Hospital Campus, Ahmedabad-16, India
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11
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Affiliation(s)
- DM Shah
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad-380016, India
| | - SB Patel
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad-380016, India
| | - SR Shah
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad-380016, India
| | - KG Goswami
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad-380016, India
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12
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Pote ST, Khan U, Lahiri KK, Patole MS, Thakar MR, Shah SR. Onychomycosis due to Achaetomium strumarium. J Mycol Med 2018; 28:510-513. [PMID: 30104134 DOI: 10.1016/j.mycmed.2018.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/05/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
Onychomycosis is the most common infection of the toe-nails or finger-nails and it may be caused by a large variety of fungal species. Achaetomium species which belong to the phylum Ascomycota (Family Chaetomiaceae), are usually soil saprophytes or endophytic fungi which have been rarely reported as human or animal pathogens. Here, we report a case of onychomycosis caused by Achaetomium strumarium in a healthy person who showed involvement of all fingers of both hands with yellowish brown discoloration. The causative agent isolated was identified as Achaetomium species by morphology, colony morphometry and growth at high temperature and as A. strumarium from DNA sequence of ITS region. Onychomycosis from this case responded satisfactorily with per os (P. O.; oral) and topical application of Terbinafine.
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Affiliation(s)
- S T Pote
- National Centre for Cell Science, S P Pune University Campus, Pune, India; National Aids Research Institute, Pune, India
| | - U Khan
- Bharti Vidyapeeth Deemed University Medical College, Bharati Vidyapeeth, Pune, India
| | - K K Lahiri
- Bharti Vidyapeeth Deemed University Medical College, Bharati Vidyapeeth, Pune, India
| | - M S Patole
- National Centre for Cell Science, S P Pune University Campus, Pune, India
| | - M R Thakar
- National Aids Research Institute, Pune, India
| | - S R Shah
- Bharti Vidyapeeth Deemed University Medical College, Bharati Vidyapeeth, Pune, India.
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13
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Pote ST, Chakraborty A, Lahiri KK, Patole MS, Deshmukh RA, Shah SR. Keratitis by a rare pathogen Colletotrichum gloeosporioides: A case report. J Mycol Med 2017; 27:407-411. [PMID: 28501467 DOI: 10.1016/j.mycmed.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/22/2017] [Accepted: 04/04/2017] [Indexed: 11/19/2022]
Abstract
Colletotrichum species have been reported infrequently as the cause of keratitis or subcutaneous lesions. The patient we describe developed keratitis after ocular trauma. The sample from the corneal scrapings grew Colletotrichum gloeosporioides as identified from morphological characters and DNA sequence of the 'Internal Transcribed Spacer' (ITS) region. The patient underwent topical application of amphotericin-B followed by itraconazole and natamycin treatment. Simultaneous oral voriconazole regimen leads to complete regression of corneal ulcer. This report highlights the fact that early and accurate identification and therapy can resolve keratitis caused by rare pathogen C. gloeosporioides.
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Affiliation(s)
- S T Pote
- National centre for cell science, S.P. Pune university campus, 411004 Pune, India
| | - A Chakraborty
- Department of microbiology, Bharati Vidyapeeth Deemed university medical college, 411043 Pune, India
| | - K K Lahiri
- Department of microbiology, Bharati Vidyapeeth Deemed university medical college, 411043 Pune, India
| | - M S Patole
- National centre for cell science, S.P. Pune university campus, 411004 Pune, India
| | | | - S R Shah
- Department of microbiology, Bharati Vidyapeeth Deemed university medical college, 411043 Pune, India.
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Shah SR, Chowdhury A, Mehta R, Kapoor D, Duseja A, Koshy A, Shukla A, Sood A, Madan K, Sud R, Nijhawan S, Pawan R, Prasad M, Kersey K, Jiang D, Svarovskaia E, Doehle B, Kanwar B, Subramanian M, Acharya SK, Sarin S. Sofosbuvir plus ribavirin in treatment-naïve patients with chronic hepatitis C virus genotype 1 or 3 infection in India. J Viral Hepat 2017; 24:371-379. [PMID: 27933698 DOI: 10.1111/jvh.12654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022]
Abstract
Until 2014, pegylated interferon plus ribavirin was the recommended standard of care for the treatment of chronic hepatitis C virus (HCV) infection in India. This open-label phase 3b study, conducted across 14 sites in India between 31 March 2014 and 30 November 2015, evaluated the efficacy and safety of sofosbuvir plus ribavirin therapy among treatment-naïve patients with chronic genotype 1 or 3 HCV infection. A total of 117 patients with genotype 1 or 3 HCV infection were randomized 1:1 to receive sofosbuvir 400 mg and weight-based ribavirin (1000 or 1200 mg) daily for 16 or 24 weeks. Among those with genotype 1 infection, the primary efficacy endpoint of sustained virologic response at 12 weeks post-treatment (SVR12) was reported in 90% (95% confidence intervals [CI], 73-98) and 96% (95% CI, 82-100) of patients following 16 and 24 weeks of treatment, respectively. For patients with genotype 3 infection, SVR12 rates were 100% (95% CI, 88-100) and 93% (95% CI, 78-99) after 16 and 24 weeks of therapy, respectively. Adverse events, most of which were mild or moderate in severity, occurred in 69% and 57% of patients receiving 16 and 24 weeks of treatment, respectively. The most common treatment-emergent adverse events were asthenia, headache and cough. Only one patient in the 24-week group discontinued treatment with sofosbuvir during this study. Overall, sofosbuvir plus ribavirin therapy achieved SVR12 rates ≥90% and was well tolerated among treatment-naïve patients with chronic genotype 1 or 3 HCV infection in India.
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Affiliation(s)
- S R Shah
- Global Hospitals, Mumbai, Maharashtra, India
| | - A Chowdhury
- Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - R Mehta
- Nirmal Hospital Pvt Ltd, Surat, Gujarat, India
| | - D Kapoor
- Global Hospitals, Hyderabad, Andhra Pradesh, India
| | - A Duseja
- Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - A Koshy
- Lakeshore Hospital, Kochi, Kerala, India
| | - A Shukla
- Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - A Sood
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - K Madan
- Artemis Hospitals, Gurgaon, Haryana, India
| | - R Sud
- Medanta - The Medicity, Gurgaon, Haryana, India
| | - S Nijhawan
- Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - R Pawan
- Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - M Prasad
- VGM Hospital, Coimbatore, Tamil Nadu, India
| | - K Kersey
- Gilead Sciences, Inc., Foster City, CA, USA
| | - D Jiang
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - B Doehle
- Gilead Sciences, Inc., Foster City, CA, USA
| | - B Kanwar
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - S K Acharya
- All India Institute of Medical Science, New Delhi, Delhi, India
| | - S Sarin
- Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
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McKenna JT, Shah SR, Anderson-Chernishof MB, Gamble MC, McCoy JG, Strecker RE. 0254 INSOMNIA-RELATED SLEEP DISRUPTION IMPAIRS SLEEP-DEPENDENT MEMORY CONSOLIDATION IN THE RAT. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.253] [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: 11/14/2022] Open
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16
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Dey S, Ghosh M, Rangra NK, Kant K, Shah SR, Pradhan PK, Singh S. High-Performance Liquid Chromatography Determination of Praziquantel in Rat Plasma; Application to Pharmacokinetic Studies. Indian J Pharm Sci 2017. [DOI: 10.4172/pharmaceutical-sciences.1000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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17
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Mountziaris PM, Shah SR, Lam J, Bennett GN, Mikos AG. A rapid, flexible method for incorporating controlled antibiotic release into porous polymethylmethacrylate space maintainers for craniofacial reconstruction. Biomater Sci 2016; 4:121-9. [PMID: 26340063 PMCID: PMC4679697 DOI: 10.1039/c5bm00175g] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Severe injuries in the craniofacial complex, resulting from trauma or pathology, present several challenges to functional and aesthetic reconstruction. The anatomy and position of the craniofacial region make it vulnerable to injury and subsequent local infection due to external bacteria as well as those from neighbouring structures like the sinuses, nasal passages, and mouth. Porous polymethylmethacrylate (PMMA) "space maintainers" have proven useful in staged craniofacial reconstruction by promoting healing of overlying soft tissue prior to reconstruction of craniofacial bones. We describe herein a method by which the porosity of a prefabricated porous PMMA space maintainer, generated by porogen leaching, can be loaded with a thermogelling copolymer-based drug delivery system. Porogen leaching, space maintainer prewetting, and thermogel loading all significantly affected the loading of a model antibiotic, colistin. Weeks-long release of antibiotic at clinically relevant levels was achieved with several formulations. In vitro assays confirmed that the released colistin maintained its antibiotic activity against several bacterial targets. Our results suggest that this method is a valuable tool in the development of novel therapeutic approaches for the treatment of severe complex, infected craniofacial injuries.
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Affiliation(s)
- P M Mountziaris
- Department of Bioengineering, Rice University, Houston, Texas, USA. and Division of Plastic Surgery, Albany Medical Center, Albany, NY, USA
| | - S R Shah
- Department of Bioengineering, Rice University, Houston, Texas, USA.
| | - J Lam
- Department of Bioengineering, Rice University, Houston, Texas, USA.
| | - G N Bennett
- Department of BioSciences, Rice University, Houston, Texas, USA.
| | - A G Mikos
- Department of Bioengineering, Rice University, Houston, Texas, USA.
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Shah SR, Alam MT, Shah SA, Altaf A, Khan M. Urban and rural population comparison of hepatic profile and associated etiology among children with end-stage renal disease. Indian J Nephrol 2016; 26:473-474. [PMID: 27942187 PMCID: PMC5131394 DOI: 10.4103/0971-4065.181885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Vo TN, Shah SR, Lu S, Tatara AM, Lee EJ, Roh TT, Tabata Y, Mikos AG. Injectable dual-gelling cell-laden composite hydrogels for bone tissue engineering. Biomaterials 2015; 83:1-11. [PMID: 26773659 DOI: 10.1016/j.biomaterials.2015.12.026] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [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: 11/02/2015] [Revised: 12/15/2015] [Accepted: 12/19/2015] [Indexed: 02/07/2023]
Abstract
The present work investigated the osteogenic potential of injectable, dual thermally and chemically gelable composite hydrogels for mesenchymal stem cell (MSC) delivery in vitro and in vivo. Composite hydrogels comprising copolymer macromers of N-isopropylacrylamide were fabricated through the incorporation of gelatin microparticles (GMPs) as enzymatically digestible porogens and sites for cellular attachment. High and low polymer content hydrogels with and without GMP loading were shown to successfully encapsulate viable MSCs and maintain their survival over 28 days in vitro. GMP incorporation was also shown to modulate alkaline phosphatase production, but enhanced hydrogel mineralization along with higher polymer content even in the absence of cells. Moreover, the regenerative capacity of 2 mm thick hydrogels with GMPs only, MSCs only, or GMPs and MSCs was evaluated in vivo in an 8 mm rat critical size cranial defect for 4 and 12 weeks. GMP incorporation led to enhanced bony bridging and mineralization within the defect at each timepoint, and direct bone-implant contact as determined by microcomputed tomography and histological scoring, respectively. Encapsulation of both GMPs and MSCs enabled hydrogel degradation leading to significant tissue infiltration and osteoid formation. The results suggest that these injectable, dual-gelling cell-laden composite hydrogels can facilitate bone ingrowth and integration, warranting further investigation for bone tissue engineering.
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Affiliation(s)
- T N Vo
- Department of Bioengineering, Rice University, P.O. Box 1892, MS 142, Houston, TX, 77251-1892, USA
| | - S R Shah
- Department of Bioengineering, Rice University, P.O. Box 1892, MS 142, Houston, TX, 77251-1892, USA
| | - S Lu
- Department of Bioengineering, Rice University, P.O. Box 1892, MS 142, Houston, TX, 77251-1892, USA
| | - A M Tatara
- Department of Bioengineering, Rice University, P.O. Box 1892, MS 142, Houston, TX, 77251-1892, USA
| | - E J Lee
- Department of Bioengineering, Rice University, P.O. Box 1892, MS 142, Houston, TX, 77251-1892, USA
| | - T T Roh
- Department of Bioengineering, Rice University, P.O. Box 1892, MS 142, Houston, TX, 77251-1892, USA
| | - Y Tabata
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
| | - A G Mikos
- Department of Bioengineering, Rice University, P.O. Box 1892, MS 142, Houston, TX, 77251-1892, USA; Department of Chemical and Biomolecular Engineering, Rice University, P.O. Box 1892, MS 362, Houston, TX, 77251-1892, USA.
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20
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Atre AN, Mehta A, Chandorkar PR, Patole MS, Diwanay SS, Shah SR, Modak MS. Uptake of clinical yeast isolates by human epithelial cell line. J Mycol Med 2015; 26:187-92. [PMID: 26597144 DOI: 10.1016/j.mycmed.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The occurrence of yeast infections in humans has increased, with the species belonging to genus Candida still being the most common cause of infection. Nevertheless, infections caused by less common yeasts have been widely reported in recent years. The main objective of this study was to assess the potential of these less common saprophytic yeasts to invade the host cell, which is essential for causing systemic infections. MATERIAL AND METHODS Various yeast isolates were identified by DNA sequence information of PCR amplified ITS region. The purported saprophytic yeasts were characterized for internalization by mammalian cells in vitro, by staining the F-actin. CONCLUSION The identification of different yeast isolates from various patients revealed that 70% of the isolates belonged to the genus Candida, while remaining 30% of the isolates were yeasts not belonging to genus Candida. These non-Candida clinical isolates, either in yeast or hyphal forms, were efficiently internalized by human epithelial cells. The internalization was marked by a process of actin polymerization surrounding the invading yeast. Such uptake by epithelial cells signifies traversal of cell barrier by yeast cells during infection in vivo.
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Affiliation(s)
- A N Atre
- National Centre for Cell Science, Savitribai Phule Pune University Campus, Ganesh Khind, Pune 411007, India
| | - A Mehta
- National Centre for Cell Science, Savitribai Phule Pune University Campus, Ganesh Khind, Pune 411007, India
| | - P R Chandorkar
- National Centre for Cell Science, Savitribai Phule Pune University Campus, Ganesh Khind, Pune 411007, India
| | - M S Patole
- National Centre for Cell Science, Savitribai Phule Pune University Campus, Ganesh Khind, Pune 411007, India.
| | - S S Diwanay
- M.E.S. Abasaheb Garware College, Karve Road, Pune 411004, India
| | - S R Shah
- Bharati Vidyapeeth's Medical College, Pune 411043, India
| | - M S Modak
- Bharati Vidyapeeth's Medical College, Pune 411043, India
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21
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Udgaonkar US, Shah SR. Need of microbiological investigations in the case of infected hydatid cyst. Indian J Med Microbiol 2015; 33 Suppl:168. [PMID: 25657147 DOI: 10.4103/0255-0857.150981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- U S Udgaonkar
- Ex-Professor, Department of Microbiology, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli - 416 414, Maharashtra, India
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Gane E, Kershenobich D, Seguin-Devaux C, Kristian P, Aho I, Dalgard O, Shestakova I, Nymadawa P, Blach S, Acharya S, Anand AC, Andersson MI, Arendt V, Arkkila P, Baatarkhuu O, Barclay K, Ben-Ari Z, Bergin C, Bessone F, Blokhina N, Brunton CR, Choudhuri G, Chulanov V, Cisneros L, Croes EA, Dahgwahdorj YA, Daruich JR, Dashdorj NR, Davaadorj D, de Knegt RJ, de Vree M, Gadano AC, Gower E, Halota W, Hatzakis A, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kostrzewska K, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Mossong J, Norris S, Nurmukhametova E, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prins M, Puri P, Radke S, Rakhmanova A, Razavi H, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanchez Avila JF, Sanduijav R, Saraswat V, Schréter I, Shah SR, Shevaldin A, Shibolet O, Silva MO, Sokolov S, Sonderup M, Souliotis K, Spearman CW, Staub T, Stedman C, Strebkova EA, Struck D, Sypsa V, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuckerman E, Zuure FR, Prabdial-Sing N, Flisiak R, Estes C. Strategies to manage hepatitis C virus (HCV) infection disease burden - volume 2. J Viral Hepat 2015; 22 Suppl 1:46-73. [PMID: 25560841 DOI: 10.1111/jvh.12352] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 15 countries, and the relative impact of two scenarios was considered: (i) increased treatment efficacy while holding the treated population constant and (ii) increased treatment efficacy and increased annual treated population. Increasing levels of diagnosis and treatment, in combination with improved treatment efficacy, were critical for achieving substantial reductions in disease burden. In most countries, the annual treated population had to increase several fold to achieve the largest reductions in HCV-related morbidity and mortality. This suggests that increased capacity for screening and treatment will be critical in many countries. Birth cohort screening is a helpful tool for maximizing resources. In most of the studied countries, the majority of patients were born between 1945 and 1985.
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Affiliation(s)
- E Gane
- Auckland Hospital Clinical Studies Unit, Auckland, New Zealand
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23
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Hatzakis A, Chulanov V, Gadano AC, Bergin C, Ben-Ari Z, Mossong J, Schréter I, Baatarkhuu O, Acharya S, Aho I, Anand AC, Andersson MI, Arendt V, Arkkila P, Barclay K, Bessone F, Blach S, Blokhina N, Brunton CR, Choudhuri G, Cisneros L, Croes EA, Dahgwahdorj YA, Dalgard O, Daruich JR, Dashdorj NR, Davaadorj D, de Knegt RJ, de Vree M, Estes C, Flisiak R, Gane E, Gower E, Halota W, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kershenobich D, Kostrzewska K, Kristian P, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Norris S, Nurmukhametova E, Nymadawa P, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prabdial-Sing N, Prins M, Radke S, Rakhmanova A, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanchez Avila JF, Sanduijav R, Saraswat V, Seguin-Devaux C, Shah SR, Shestakova I, Shevaldin A, Shibolet O, Silva MO, Sokolov S, Sonderup M, Souliotis K, Spearman CW, Staub T, Stedman C, Strebkova EA, Struck D, Sypsa V, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuckerman E, Zuure FR, Puri P, Razavi H. The present and future disease burden of hepatitis C virus (HCV) infections with today's treatment paradigm - volume 2. J Viral Hepat 2015; 22 Suppl 1:26-45. [PMID: 25560840 DOI: 10.1111/jvh.12351] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Morbidity and mortality attributable to chronic hepatitis C virus (HCV) infection are increasing in many countries as the infected population ages. Models were developed for 15 countries to quantify and characterize the viremic population, as well as estimate the number of new infections and HCV related deaths from 2013 to 2030. Expert consensus was used to determine current treatment levels and outcomes in each country. In most countries, viremic prevalence has already peaked. In every country studied, prevalence begins to decline before 2030, when current treatment levels were held constant. In contrast, cases of advanced liver disease and liver related deaths will continue to increase through 2030 in most countries. The current treatment paradigm is inadequate if large reductions in HCV related morbidity and mortality are to be achieved.
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Affiliation(s)
- A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
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Saraswat V, Norris S, de Knegt RJ, Sanchez Avila JF, Sonderup M, Zuckerman E, Arkkila P, Stedman C, Acharya S, Aho I, Anand AC, Andersson MI, Arendt V, Baatarkhuu O, Barclay K, Ben-Ari Z, Bergin C, Bessone F, Blach S, Blokhina N, Brunton CR, Choudhuri G, Chulanov V, Cisneros L, Croes EA, Dahgwahdorj YA, Dalgard O, Daruich JR, Dashdorj NR, Davaadorj D, de Vree M, Estes C, Flisiak R, Gadano AC, Gane E, Halota W, Hatzakis A, Henderson C, Hoffmann P, Hornell J, Houlihan D, Hrusovsky S, Jarčuška P, Kershenobich D, Kostrzewska K, Kristian P, Leshno M, Lurie Y, Mahomed A, Mamonova N, Mendez-Sanchez N, Mossong J, Nurmukhametova E, Nymadawa P, Oltman M, Oyunbileg J, Oyunsuren T, Papatheodoridis G, Pimenov N, Prabdial-Sing N, Prins M, Puri P, Radke S, Rakhmanova A, Razavi H, Razavi-Shearer K, Reesink HW, Ridruejo E, Safadi R, Sagalova O, Sanduijav R, Schréter I, Seguin-Devaux C, Shah SR, Shestakova I, Shevaldin A, Shibolet O, Sokolov S, Souliotis K, Spearman CW, Staub T, Strebkova EA, Struck D, Tomasiewicz K, Undram L, van der Meer AJ, van Santen D, Veldhuijzen I, Villamil FG, Willemse S, Zuure FR, Silva MO, Sypsa V, Gower E. Historical epidemiology of hepatitis C virus (HCV) in select countries - volume 2. J Viral Hepat 2015; 22 Suppl 1:6-25. [PMID: 25560839 DOI: 10.1111/jvh.12350] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic hepatitis C virus (HCV) infection is a leading cause of liver related morbidity and mortality. In many countries, there is a lack of comprehensive epidemiological data that are crucial in implementing disease control measures as new treatment options become available. Published literature, unpublished data and expert consensus were used to determine key parameters, including prevalence, viremia, genotype and the number of patients diagnosed and treated. In this study of 15 countries, viremic prevalence ranged from 0.13% in the Netherlands to 2.91% in Russia. The largest viremic populations were in India (8 666 000 cases) and Russia (4 162 000 cases). In most countries, males had a higher rate of infections, likely due to higher rates of injection drug use (IDU). Estimates characterizing the infected population are critical to focus screening and treatment efforts as new therapeutic options become available.
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Affiliation(s)
- V Saraswat
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Dhumane PW, Kulkarni AV, Waravdekar G, Shah SR. Percutaneous hepatic venous stenting for menorrhagia in Budd-Chiari syndrome. Liver Int 2013; 33:1607. [PMID: 23648121 DOI: 10.1111/liv.12183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/25/2013] [Indexed: 02/13/2023]
Affiliation(s)
- P W Dhumane
- Department of Surgery, PD Hinduja National Hospital, Mumbai, India
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Shah SR, Gressett Ussery SM, Dowell JE, Liticker J. Response to letter titled: blood pressure monitoring in patients receiving bevacizumab. Ann Oncol 2013; 24:1127-8. [PMID: 23393124 DOI: 10.1093/annonc/mdt023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shah SR, Gressett Ussery SM, Dowell JE, Marley E, Liticker J, Arriaga Y, Verma U. Shorter bevacizumab infusions do not increase the incidence of proteinuria and hypertension. Ann Oncol 2012; 24:960-5. [PMID: 23175623 DOI: 10.1093/annonc/mds593] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A previous study has shown that shorter bevacizumab infusions (0.5 mg/kg/min) can be safely administered without increasing the risk of infusion-related hypersensitivity reactions (HSRs). However, the risk of proteinuria and hypertension in patients receiving shorter infusions of bevacizumab is undetermined. PATIENTS AND METHODS This was a multicenter, prospective, observational study in patients receiving <10 mg/kg of bevacizumab infused over 0.5 mg/kg/min. Patients were observed until discontinuation of bevacizumab for progression of cancer or toxicity. The incidence of hypertension and proteinuria was compared with a prior cohort of patients who had received standard duration infusions of bevacizumab. RESULTS Sixty-three patients received a total of 392 doses of shorter bevacizumab infusions. Nineteen (30.2%) patients experienced proteinuria while receiving bevacizumab. Out of 19 patients, 13 had grade 1 and 6 had grade 2 proteinuria. None of the patients experienced grade 3 or 4 proteinuria. Hypertension was reported in 32 (50.8%) patients receiving bevacizumab. Twelve (19%) patients developed grade 3 or greater hypertension on bevacizumab. The incidence of proteinuria and hypertension was 38.3% and 56.6%, respectively, in patients (N = 120, 1347 infusions) receiving standard duration infusions of bevacizumab. CONCLUSIONS Shorter bevacizumab infusions (0.5 mg/kg/min) do not increase the risk of proteinuria and hypertension.
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Affiliation(s)
- S R Shah
- Pharmacy Practice Department, Texas Tech University HSC-School of Pharmacy/VA North Texas Health Care System.
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Udgaonkar US, Dharamsi R, Kulkarni SA, Shah SR, Patil SS, Bhosale AL, Gadgil SA, Mohite RS. Intestinal myiasis. Indian J Med Microbiol 2012; 30:332-7. [DOI: 10.4103/0255-0857.99496] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Prashanth M, Ganesh HK, Vima MV, John M, Bandgar T, Joshi SR, Shah SR, Rathi PM, Joshi AS, Thakkar H, Menon PS, Shah NS. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus. J Assoc Physicians India 2009; 57:205-210. [PMID: 19588648] [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: 05/28/2023]
Abstract
OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) is commonly associated with type 2 diabetes mellitus (DM) though its prevalence is not well studied. We conducted a prospective study of prevalence and risk factors of NAFLD in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS 204 type 2 DM patients attending an out-patient diabetic clinic underwent abdominal sonography. Ninty of 127 patients with fatty infiltration on ultrasound consented for liver biopsy, clinical and biochemical workup. RESULTS Eighty seven percent had NAFLD on histology with 62.6% steatohepatitis and 37.3% fibrosis. Age, duration of diabetes mellitus, degree of glycemic control, body mass index, waist circumference, family history of diabetes mellitus, did not predict the presence or severity of NAFLD or fibrosis. Serum alanine aminostranferase (ALT) and alkaline phosphatase levels, though within normal limits, were significantly higher in patients with steatohepatitis. Prevalence of NASH increased with increase in the components of the metabolic syndrome. Serum AST/ALT ratio were also significantly higher (p-0.049) in patients with severe fibrosis. All patients with severe fibrosis had metabolic syndrome. CONCLUSIONS Prevalence of NAFLD and NASH in our cohort of type 2 DM patients is high and increases with multiple components of metabolic syndrome. NASH and advanced fibrosis can occur in diabetic patients without any symptoms, signs or routine laboratory test abnormalities.
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Affiliation(s)
- M Prashanth
- Department of Endocrinology, Seth GS Medical College and King Edward Memorial (KEM) Hospital, Mumbai
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Kulkarni RD, Patil SA, Kulkarni VA, Ramteerthakar M, Kumbhar V, Shah SR, Joshi PA, Jahagirdhar VL. An outbreak of cholera in the Sangli District of Maharashtra. Indian J Med Microbiol 2007; 25:76-8. [PMID: 17377366 DOI: 10.4103/0255-0857.31076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kulkarni RD, Patil SA, Kulkarni VA, Ramteerthakar M, Kumbhar V, Shah SR, Joshi PA, Jahagirdhar VL. An Outbreak of Cholera in the Sangli District of Maharashtra. Indian J Med Microbiol 2007. [DOI: 10.1016/s0255-0857(21)02248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maniar JK, Shah SR, Verma R, Kamath R, Gupte P, Maniar A. Nevirapine-induced fulminant hepatitis. J Assoc Physicians India 2006; 54:957-8. [PMID: 17334017] [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: 05/14/2023]
Abstract
Nevirapine induced hepatotoxicity is known but fatality is rare. We report a case of a young individual who developed nevirapine (NVP) induced fatal hepatitis without apparent risk factors or preceding rash. Exacerbation of underlying silent chronic liver dysfunction possibly contributed to the fatal outcome. This case stresses the need for careful evaluation, regular monitoring and prompt omission of drug on suspicion of hepatotoxicity.
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Affiliation(s)
- J K Maniar
- Department of Infectious Diseases, Jaslok Hospital and Research Centre, Mumbai, India
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Patel SB, Shah SR, Goswami KG, Jain S, Shah D, Katti A. Case report : Proteus syndrome - an unusual hamartomatous disorder. Indian J Radiol Imaging 2006. [DOI: 10.4103/0971-3026.29047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S B Patel
- Department of Radiology Gujarat Cancer And Research Institute Civil Hospital Campus, Ahmedabad - 16, Gujarat, India
| | - S R Shah
- Department of Radiology Gujarat Cancer And Research Institute Civil Hospital Campus, Ahmedabad - 16, Gujarat, India
| | - K G Goswami
- Department of Radiology Gujarat Cancer And Research Institute Civil Hospital Campus, Ahmedabad - 16, Gujarat, India
| | - S Jain
- Department of Radiology Gujarat Cancer And Research Institute Civil Hospital Campus, Ahmedabad - 16, Gujarat, India
| | - D Shah
- Department of Radiology Gujarat Cancer And Research Institute Civil Hospital Campus, Ahmedabad - 16, Gujarat, India
| | - A Katti
- Department of Radiology Gujarat Cancer And Research Institute Civil Hospital Campus, Ahmedabad - 16, Gujarat, India
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Stanford BL, Shah SR, Ballard EE, Jumper CA, Rabinowitz I, Dowell JE, Hunt WC, Krieger JA. A randomized trial assessing the utility of a test-dose program with taxanes. Curr Med Res Opin 2005; 21:1611-6. [PMID: 16238901 DOI: 10.1185/030079905x65411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Taxanes are commonly used anticancer agents with a potential of producing an allergic or hypersensitivity reaction (HSR). We performed a randomized study to evaluate the value of a test dose given prior to the full dose of either paclitaxel or docetaxel. RESEARCH DESIGN AND METHODS Patients were randomly assigned to either the administration of the full dose or to the prior administration of a 1 mg intravenous test dose of either paclitaxel or docetaxel. The primary endpoints were severity of the HSR and the cost of drug wastage due to a HSR. RESULTS Two hundred and eighteen patients were randomized from three different treatment sites. The overall incidence of HSR was 6.5% and there was no significant difference in the incidence of HSR in either group. The mean HSR severity grade was 2.8 for patients without a test dose and 2.3 for those receiving a test dose. There was, however, a reduction in the wastage of taxane in the test dose arm. Wastage avoided in the test dose arm was $1573 per patient who had a HSR and $104 per patient treated with a taxane. CONCLUSION Although a test dose may not reduce the severity of a HSR with the administration of a taxane, it does reduce the cost associated with drug wastage.
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Affiliation(s)
- B L Stanford
- Texas Tech University Health Sciences Center School of Pharmacy, Lubbock & Dallas, TX, USA
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Shah SR, Shah DM, Patel SB, Goswami KG. Radiological case report : Solid and papillary epithelial neoplasm, a case report. Indian J Radiol Imaging 2005. [DOI: 10.4103/0971-3026.28799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- SR Shah
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad-3800016, India
| | - DM Shah
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad-3800016, India
| | - SB Patel
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad-3800016, India
| | - KG Goswami
- Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad-3800016, India
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Shah SR, Deshmukh HL, Mathur SK. Extensive portal and splenic vein thrombosis: differences in hemodynamics and management. Hepatogastroenterology 2003; 50:1085-9. [PMID: 12845987] [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: 03/03/2023]
Abstract
BACKGROUND/AIMS To assess the incidence of extensive portal and splenic vein thrombosis in patients with extrahepatic portal vein obstruction and determine the differences in presentation, portal hemodynamics and management as compared to patients with portal vein thrombosis alone. METHODOLOGY 118 patients of extrahepatic portal vein obstruction presenting with variceal hemorrhage, having received no definitive treatment prior to presentation were divided into two groups--with portal and splenic vein thrombosis and with portal vein thrombosis, based on ultrasonography and splenoportography. Collateralization patterns on splenoportography were studied. Results of endoscopic variceal sclerotherapy were compared. RESULTS Portal and splenic vein thrombosis was seen in 39 patients. Collateralization in case of portal and splenic vein thrombosis, in contrast to portal vein thrombosis, was predominantly left sided (74% vs. 9%, p < 0.0001). Fundal gastric varices were seen more often in patients with portal and splenic vein thrombosis (28% vs. 11%, p = 0.02), developing even after variceal obliteration, though obliteration was achieved in fewer sessions. Surgery for control of variceal bleed was performed more in the portal and splenic vein thrombosis group (33% vs. 15%, p = 0.02), especially for gastric varices (28% vs. 9%, p = 0.006). CONCLUSIONS Portal and splenic vein thrombosis is present in 33% of patients with extrahepatic portal vein obstruction. Hemodynamic patterns differ, accounting for the preponderance of gastric varices on presentation in patients with portal and splenic vein thrombosis and an increased need for surgery.
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Affiliation(s)
- S R Shah
- Gastroenterology Surgical Services, Seth G.S. Medical College, King Edward VII Memorial Hospital, Bombay, India.
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Shah SR, Gupta AD, Sharma A, Joshi A, Desai D, Abraham P. Acute superior mesenteric vein thrombosis associated with factor V 'Leiden' gene mutation. J Assoc Physicians India 2003; 51:611-3. [PMID: 15266932] [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: 04/30/2023]
Abstract
OBJECTIVES To study thrombophilia states in Indian patients with acute spontaneous superior mesenteric vein thrombosis (SMVT). METHODS Two men with this condition, a 56 year old and a 31 year old presenting with acute SMVT, demonstrated on CT scan, were subjected to a thrombophilia screen consisting of Protein C, S, antithrombin levels, lupus anticoagulant, anticardiolipin antibodies, fibrinogen levels, factor VIII levels, factor V 'Leiden' gene mutation, and paroxysmal nocturnal hematuria screen. RESULTS A thrombophilia screen showed factor V 'Leiden' gene mutation (heterozygous) in both cases. Additionally, the first patient had high fibrinogen levels and the second high factor VIII levels. Both patients are currently on long-term anticoagulation. CONCLUSION Factor V 'Leiden' gene mutation in association with other thrombophilic factors may predispose to spontaneous superior mesenteric vein thrombosis.
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Affiliation(s)
- S R Shah
- Section of GI Surgery, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai 400 016, India
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Khan AW, Dhillon AP, Hutchins R, Abraham A, Shah SR, Snooks S, Davidson BR. Prognostic significance of intratumoural microvessel density (IMD) in resected pancreatic and ampullary cancers to standard histopathological variables and survival. Eur J Surg Oncol 2002; 28:637-44. [PMID: 12359201 DOI: 10.1053/ejso.2002.1307] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM Angiogenesis is required for tumour growth. Its evaluation, by intratumoural microvessel density (IMD), has prognostic significance in many solid tumours. There is controversy regarding its use in pancreatic cancer and little is known about its role in ampullary tumours. The aim is to study IMD as a prognostic marker in resected ductal adenocarcinomas of head of pancreas and cancers of the ampullary region. METHODS Forty-seven patients (23 pancreatic and 24 ampullary, mean age 62.0 years) surviving a potentially curative (R0/R1) resection were analysed. Paraffin-embedded sections of these tumours were immunohistochemically stained for CD-34 and IMD was determined (magnification x200). This was correlated with histopathological data and survival using Cox's multivariate analysis. RESULTS Mean survival for the pancreatic cancer group was 18.4 months (SE=2.7) and 81.2 months (SE=9.9) for the ampullary cancer group. In the pancreatic cancer group, IMD was found to have independent prognostic significance to survival on multivariate analysis (P=0.002, Hazard Ratio (HR) 13.60) along with microscopic resection margin involvement (P=0.003, HR 15.18). For ampullary cancers, IMD was higher in those with lymph node metastasis (P=0.02, Mann-Whitney U -test). CONCLUSION IMD in resected pancreatic cancers correlates with survival.
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Affiliation(s)
- A W Khan
- University Department of Surgery, Royal Free & University College Medical School, University College London, UK
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Shah SR. The difficulties in carrying out this study comparing three established modalities of preventing recurrent variceal hemorrhage in patients with portal hypertension. Ann Surg 2001; 234:263-5. [PMID: 11505074 PMCID: PMC1422015 DOI: 10.1097/00000658-200108000-00019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Shah SR. Re: Orozco et al. A comparative study of the elective treatment of variceal hemorrhage with beta-blockers, transendoscopic sclerotherapy and surgery. A prospective, controlled, and randomized trial during 10 years. Ann Surg 2000; 232:216-9. Ann Surg 2001; 234:133-4. [PMID: 11420496 PMCID: PMC1421962 DOI: 10.1097/00000658-200107000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shah SR, Sirivatanauksorn Y, Spalding DR, Davidson BR. Laparoscopic resection of liver metastasis using a harmonic scalpel. Indian J Gastroenterol 2001; 20:72-3. [PMID: 11305498] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report successful laparoscopic resection of a solitary liver metastasis from a colorectal carcinoma in an obese man, using a harmonic scalpel.
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Affiliation(s)
- S R Shah
- University Department of Surgery, Royal Free and University College Medical School, London, UK.
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Shah SR, Rastegar DA, Nicol TL. Case report. Diagnosis of disseminated Mycobacterium avium complex infection by liver biopsy. AIDS Read 2000; 10:669-72. [PMID: 11186192] [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: 02/19/2023]
Abstract
Mycobacterium avium complex (MAC) infection is a common complication of HIV/AIDS. Signs and symptoms of this infection are nonspecific and include fever, weight loss, diarrhea, and abnormal levels of liver enzymes, especially elevated alkaline phosphatase levels. Diagnosis can be achieved through several methods, but liver biopsy may be the most rapid and efficient. We present a case that illustrates the potential value of liver biopsy in diagnosing disseminated MAC infection.
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Affiliation(s)
- S R Shah
- Kaiser Permanente, Cold Springs, Md., USA
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Abstract
SUMMARY More patients with less severe type biliary injury are being referred earlier to a specialist hepatobiliary unit. Most patients still have ineffective corrective surgery before transfer. Presented in part to the European Congress of the International Hepato-Pancreatico-Biliary Association in Budapest, Hungary, May 1999 and published in abstract form as Digestive Surgery 1999; 16(Suppl 1): 32.
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Affiliation(s)
- S R Shah
- Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, University Hospitals of Birmingham NHS Trust, Edgbaston, Birmingham B15 2TH, UK
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Shah SR. Re: Pelvic fracture urethral injuries: the unresolved controversy. J Urol 2000; 163:1258-9. [PMID: 10737520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Abstract
BACKGROUND Currently used predictors for bile duct calculi in patients undergoing cholecystectomy have low specificity resulting in unnecessary cholangiograms being performed. The role of biliary scintiscan in predicting the presence of bile duct calculi was assessed. METHODS Seventy-five patients with symptomatic gallstone disease were studied prospectively regard- ing the value of a history of jaundice or acute pancreatitis, raised serum bilirubin and serum alkaline phosphatase levels, and visualization of stones or presence of dilated bile ducts on ultrasonography (standard criteria) in detecting bile duct calculi. Results of biliary scintiscan were evaluated against a combination of standard criteria. The 'gold standard' for evaluation was endoscopic or peroperative cholangiography. RESULTS Biliary scintiscan had a higher sensitivity and specificity (93 and 94 per cent) than a combination of the above standard and modified predictors for biliary calculi (89 and 71 per cent). A combination of ultrasonography and selective use of scintiscan, in the absence of bile duct dilatation only, had higher values (96 and 98 per cent). CONCLUSION A combination of ultrasonography and biliary scintiscan can accurately predict bile duct calculi and could be used as a guide for selective cholangiography.
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Affiliation(s)
- S K Mathur
- Department of Surgery and Gastrointestinal Surgical Services, King Edward VII Memorial Hospital, Bombay 400 012, India
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Mathur SK, Shah SR, Nagral SS, Soonawala ZF. Transabdominal extensive esophagogastric devascularization with gastroesophageal stapling for management of noncirrhotic portal hypertension: long-term results. World J Surg 1999; 23:1168-74; discussion 1174-5. [PMID: 10501880 DOI: 10.1007/s002689900641] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Outside Japan portosystemic shunts have been favored as the surgical procedure of choice for the management of portal hypertension of noncirrhotic etiology. Devascularization procedures have resulted in high rebleed rates probably owing to a limited extent of devascularization. We performed this study to assess the efficacy of our modification of Sugiura's procedure for long-term control of variceal bleeding in patients with noncirrhotic portal hypertension. Forty-six patients with extrahepatic portal venous obstruction (EHPVO) and 22 with noncirrhotic portal fibrosis (NCPF) were subjected to transabdominal extensive esophagogastric devascularization with esophageal or gastric stapled transection (modified Sugiura's procedure), 38 in an emergency situation and 30 electively. Follow-up endoscopies were performed every 6 months. Operative mortality, morbidity, variceal status, and causes of recurrent bleeding were evaluated. The postoperative mortality was 4%. Early procedure-related complications were seen in 6%, and esophageal strictures formed in 7 of 45 survivors undergoing esophageal transection (15%). Over a mean +/- SD follow-up of 53 +/- 34 months, 95% of patients were free of varices. Seven survivors (11%) had a rebleed, but only 5% were due to varices (two esophageal, one gastric). Six (9%) patients developed gastropathy. The 5-year survival was 88%. The modified Sugiura's procedure is safe and effective for long-term control of variceal bleeding especially in the emergency setting and in patients with anatomy unsuitable for shunt surgery or if surgical expertise for a shunt operation is not available.
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Affiliation(s)
- S K Mathur
- Department of Surgery and Gastroenterology Surgical Services, King Edward VII Memorial Hospital, Bombay 400 012, India
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Abstract
OBJECTIVE To study the incidence of antral varices (AV) and their fate in patients with portal hypertension so as to formulate a management policy. DESIGN Prospective cohort study. SETTING Single surgical unit specializing in portal hypertension management in a tertiary level centre. PARTICIPANTS Three hundred and seventy-one patients [cirrhosis 170, non-cirrhotic portal fibrosis (NCPF) 53, extrahepatic portal venous obstruction (EHPVO) 148] with history of bleeding from oesophageal varices were inducted in the chronic sclerotherapy programme. INTERVENTIONS Protocol-based endoscopic sclerotherapy and management of bleeding for oesophageal varices. OUTCOME MEASURES Development or disappearance of AV, bleeding from AV. RESULTS No patient had AV on index endoscopy. Thirteen (3.5%) patients developed AV, in cirrhosis 2.9%, EHPVO 4.1%, NCPF 3.8% (P = 0.86). AV developed after a mean of 15 months. Oesophageal varices took a longer number of sessions to obliterate in patients with AV (11.1 vs 5.98 sessions, P<0.0001). Only one patient bled, having coexistent oesophageal varices and gastropathy. AV disappeared spontaneously in seven patients, recurring in only one. Of seven persisting AV, none have bled over a mean follow-up of 30 months (SD 23.2). CONCLUSIONS AV are seen in a small proportion of patients, and are distributed equally amongst the aetiologies of portal hypertension. They rarely bleed and may be ignored during sclerotherapy of oesophageal varices.
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Affiliation(s)
- S R Shah
- Gastroenterology Surgical Services, King Edward VII Memorial Hospital, Bombay, India.
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