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Patel V, Levick B, Boult S, Gibbons DC, Drysdale M, Lloyd EJ, Singh M, Birch HJ. Characteristics and outcomes of COVID-19 patients presumed to be treated with sotrovimab in NHS hospitals in England. BMC Infect Dis 2024; 24:428. [PMID: 38649824 PMCID: PMC11036565 DOI: 10.1186/s12879-024-09311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The impact of the constantly evolving severe acute respiratory syndrome coronavirus 2 on the effectiveness of early coronavirus disease 2019 (COVID-19) treatments is unclear. Here, we report characteristics and acute clinical outcomes of patients with COVID-19 treated with a monoclonal antibody (mAb; presumed to be sotrovimab) across six distinct periods covering the emergence and predominance of Omicron subvariants (BA.1, BA.2, and BA.5) in England. METHODS Retrospective cohort study using data from the Hospital Episode Statistics database from January 1-July 31, 2022. Included patients received a mAb delivered by a National Health Service (NHS) hospital as a day-case, for which the primary diagnosis was COVID-19. Patients were presumed to have received sotrovimab based on NHS data showing that 99.98% of COVID-19-mAb-treated individuals received sotrovimab during the study period. COVID-19-attributable hospitalizations were reported overall and across six distinct periods of Omicron subvariant prevalence. Subgroup analyses were conducted in patients with severe renal disease and active cancer. RESULTS Among a total of 10,096 patients, 1.0% (n = 96) had a COVID-19-attributable hospitalization, 4.6% (n = 465) had a hospital visit due to any cause, and 0.3% (n = 27) died due to any cause during the acute period. COVID-19-attributable hospitalization rates were consistent among subgroups, and no significant differences were observed across periods of Omicron subvariant predominance. CONCLUSIONS Levels of COVID-19-attributable hospitalizations and deaths were low in mAb-treated patients and among subgroups. Similar hospitalization rates were observed whilst Omicron BA.1, BA.2, and BA.5 were predominant, despite reported reductions in in vitro neutralization activity of sotrovimab against BA.2 and BA.5.
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Affiliation(s)
- Vishal Patel
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK
| | | | | | - Daniel C Gibbons
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK
| | - Myriam Drysdale
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK.
| | - Emily J Lloyd
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK
| | - Moushmi Singh
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK
| | - Helen J Birch
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK
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Patel V, Tao S, Zhou X, Lin C, Westerhold E, Grewal S, Middlebrooks EH. Real-Time Optimal Synthetic Inversion Recovery Image Selection (RT-OSIRIS) for Deep Brain Stimulation Targeting. J Imaging Inform Med 2024:10.1007/s10278-024-01117-7. [PMID: 38639807 DOI: 10.1007/s10278-024-01117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
Deep brain stimulation (DBS) is a method of electrical neuromodulation used to treat a variety of neuropsychiatric conditions including essential tremor, Parkinson's disease, epilepsy, and obsessive-compulsive disorder. The procedure requires precise placement of electrodes such that the electrical contacts lie within or in close proximity to specific target nuclei and tracts located deep within the brain. DBS electrode trajectory planning has become increasingly dependent on direct targeting with the need for precise visualization of targets. MRI is the primary tool for direct visualization, and this has led to the development of numerous sequences to aid in visualization of different targets. Synthetic inversion recovery images, specified by an inversion time parameter, can be generated from T1 relaxation maps, and this represents a promising method for modifying the contrast of deep brain structures to accentuate target areas using a single acquisition. However, there is currently no accessible method for dynamically adjusting the inversion time parameter and observing the effects in real-time in order to choose the optimal value. In this work, we examine three different approaches to implementing an application for real-time optimal synthetic inversion recovery image selection and evaluate them based on their ability to display continually-updated synthetic inversion recovery images as the user modifies the inversion time parameter. These methods include continuously computing the inversion recovery equation at each voxel in the image volume, limiting the computation only to the voxels of the orthogonal slices currently displayed on screen, or using a series of lookup tables with precomputed solutions to the inversion recovery equation. We find the latter implementation provides for the quickest display updates both when modifying the inversion time and when scrolling through the image. We introduce a publicly available cross-platform application built around this conclusion. We also briefly discuss other details of the implementations and considerations for extensions to other use cases.
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Affiliation(s)
- Vishal Patel
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA.
| | - Shengzhen Tao
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Xiangzhi Zhou
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Sanjeet Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
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Drysdale M, Galimov ER, Yarwood MJ, Patel V, Levick B, Gibbons DC, Watkins JD, Young S, Pierce BF, Lloyd EJ, Kerr W, Birch HJ, Kamalati T, Brett SJ. Comparative effectiveness of sotrovimab versus no treatment in non-hospitalised high-risk COVID-19 patients in north west London: a retrospective cohort study. BMJ Open Respir Res 2024; 11:e002238. [PMID: 38575338 PMCID: PMC11002339 DOI: 10.1136/bmjresp-2023-002238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND We assessed the effectiveness of sotrovimab vs no early COVID-19 treatment in highest-risk COVID-19 patients during Omicron predominance. METHODS Retrospective cohort study using the Discover dataset in North West London. Included patients were non-hospitalised, aged ≥12 years and met ≥1 National Health Service highest-risk criterion for sotrovimab treatment. We used Cox proportional hazards models to compare HRs of 28-day COVID-19-related hospitalisation/death between highest-risk sotrovimab-treated and untreated patients. Age, renal disease and Omicron subvariant subgroup analyses were performed. RESULTS We included 599 sotrovimab-treated patients and 5191 untreated patients. Compared with untreated patients, the risk of COVID-19 hospitalisation/death (HR 0.50, 95% CI 0.24, 1.06; p=0.07) and the risk of COVID-19 hospitalisation (HR 0.43, 95% CI 0.18, 1.00; p=0.051) were both lower in the sotrovimab-treated group; however, statistical significance was not reached. In the ≥65 years and renal disease subgroups, sotrovimab was associated with a significantly reduced risk of COVID-19 hospitalisation, by 89% (HR 0.11, 95% CI 0.02, 0.82; p=0.03) and 82% (HR 0.18, 95% CI 0.05, 0.62; p=0.007), respectively. CONCLUSIONS Risk of COVID-19 hospitalisation in sotrovimab-treated patients aged ≥65 years and with renal disease was significantly lower compared with untreated patients. Overall, risk of hospitalisation was also lower for sotrovimab-treated patients, but statistical significance was not reached.
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Affiliation(s)
| | | | | | | | - Bethany Levick
- Evidence & Access, OPEN Health Communications LLP, London, UK
| | | | | | | | | | | | - William Kerr
- Global Medical Affairs, GSK, Brentford, Middlesex, UK
| | | | | | - Stephen J Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
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Ostrosky-Frid M, Patel V. Watering Collecting Duct Cysts: Are Aquaporin2+ Progenitors the Answer? J Am Soc Nephrol 2024; 35:387-388. [PMID: 38557785 PMCID: PMC11000719 DOI: 10.1681/asn.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Mauricio Ostrosky-Frid
- Division of Nephrology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
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Patel V, Patel J, Gan J, Rahiminejad M, Preston R, Mak SM, Benedetti G. Reporting of coronary artery calcification on chest CT studies in patients with interstitial lung disease. Clin Radiol 2024; 79:e532-e538. [PMID: 38242805 DOI: 10.1016/j.crad.2023.11.028] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/03/2023] [Accepted: 11/29/2023] [Indexed: 01/21/2024]
Abstract
AIM To evaluate the prevalence of coronary artery calcification (CAC) on non-contrast computed tomography (CT) of the thorax in patients with interstitial lung disease (ILD), assess consistency of CAC reporting and assess incidence of subsequent cardiac events. MATERIALS AND METHODS Patients with known interstitial lung disease who underwent a CT thorax over a 2-year period were retrospectively reviewed. Presence of CAC was assessed using a visual scale for CAC reporting and graded as mild, moderate, or severe by two cardiothoracic radiologists. CT reports were reviewed to determine if presence of CAC had been described. Electronic medical records were reviewed for any subsequent cardiothoracic events from the date of the CT thorax to present. RESULTS 254 patients were included in the analysis (54.7% men; mean age 59.9 yo). 43.7% had CAC on their CT thorax; however, in 87.3% of those, reports did not comment on its presence. 8 patients had cardiac events; 7 of them had CAC on CT although only in 1 case this was reported. Global CAC and LAD CAC Patients with cardiac events had a significantly higher global CAC (p=0.016) and LAD CAC (p=0.048) when compared to patients without. CONCLUSION We demonstrated a high prevalence of CAC in ILD patients and its significant association with adverse cardiac events. Unfortunately, CAC on CT thorax is still largely unreported. As per recent BSCI/BSCCT and BSTI guidelines, reporting of CAC should become part of routine practice, as may prompt prevention and impact on patients outcome.
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Affiliation(s)
- V Patel
- The Royal Marsden, Fulham Road, London, SW3 6JJ, UK
| | - J Patel
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - J Gan
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - M Rahiminejad
- National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - R Preston
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - S M Mak
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - G Benedetti
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
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Castillo PR, Patel V, Mera RM, Rumbea DA, Del Brutto OH. Choroid plexus calcifications are not associated with putative markers of glymphatic dysfunction: A population study in middle-aged and older adults. Neuroradiol J 2024:19714009241240315. [PMID: 38490679 DOI: 10.1177/19714009241240315] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND AND PURPOSE Recent studies have suggested an association between dysfunction of the choroid plexus and the glymphatic system. However, information is inconclusive. Following a population-based study design, we aimed to assess the association between choroid plexus calcifications (CPCs)-as a surrogate of choroid plexus dysfunction-and severity and progression of putative markers of glymphatic dysfunction, including white matter hyperintensities (WMH) of presumed vascular origin and abnormally enlarged basal ganglia perivascular spaces (BG-PVS). METHODS This study recruited community-dwellers aged ≥40 years living in neighboring Ecuadorian villages. Participants who had baseline head CTs and brain MRIs were included in cross-sectional analyses and those who additional had follow-up MRIs (after a mean of 6.4 ± 1.5 years) were included in longitudinal analyses. Logistic and Poisson regression models, adjusted for demographics and cardiovascular risk factors, were fitted to assess associations between CPCs and WMH and enlarged BG-PVS severity and progression. RESULTS A total of 590 individuals were included in the cross-sectional component of the study, and 215 in the longitudinal component. At baseline, 25% of participants had moderate-to-severe WMH and 27% had abnormally enlarged BG-PVS. At follow-up, 36% and 20% of participants had WMH and enlarged BG-PVS progression, respectively. Logistic regression models showed no significant differences between CPCs volumes stratified in quartiles and severity of WMH and enlarged BG-PVS. Poisson regression models showed no association between the exposure and WMH and enlarged BG-PVS progression. Baseline age remained significant in these models. CONCLUSIONS Choroid plexus calcifications are not associated with putative markers of glymphatic system dysfunction.
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Affiliation(s)
| | - Vishal Patel
- Department of Radiology, Mayo Clinic College of Medicine, Jacksonville, FL, USA
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
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Ratneswaren T, Chan N, Aeron-Thomas J, Sait S, Adesalu O, Alhawamdeh M, Benger M, Garnham J, Dixon L, Tona F, McNamara C, Taylor E, Lobotesis K, Lim E, Goldberg O, Asmar N, Evbuomwan O, Banerjee S, Holm-Mercer L, Senor J, Tsitsiou Y, Tantrige P, Taha A, Ballal K, Mattar A, Daadipour A, Elfergani K, Barker R, Chakravartty R, Murchison AG, Kemp BJ, Simister R, Davagnanam I, Wong OY, Werring D, Banaras A, Anjari M, Rodrigues JCL, Thompson CAS, Haines IR, Burnett TA, Zaher REY, Reay VL, Banerjee M, Sew Hee CSL, Oo AP, Lo A, Rogers P, Hughes T, Marin A, Mukherjee S, Jaber H, Sanders E, Owen S, Bhandari M, Sundayi S, Bhagat A, Elsakka M, Hashmi OH, Lymbouris M, Gurung-Koney Y, Arshad M, Hasan I, Singh N, Patel V, Rahiminejad M, Booth TC. COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2). Neuroimage Clin 2024; 42:103590. [PMID: 38513535 DOI: 10.1016/j.nicl.2024.103590] [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: 01/26/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19. OBJECTIVE To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients. METHODS In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed. RESULTS CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality. CONCLUSION Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.
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Affiliation(s)
- T Ratneswaren
- Charing Cross Hospital, London, UK; Addenbrooke's Hospital, Cambridge, UK
| | - N Chan
- Royal London Hospital, London, UK
| | | | - S Sait
- King's College Hospital, London, UK
| | | | | | - M Benger
- King's College Hospital, London, UK
| | | | - L Dixon
- Charing Cross Hospital, London, UK
| | - F Tona
- Charing Cross Hospital, London, UK
| | | | - E Taylor
- Charing Cross Hospital, London, UK
| | | | - E Lim
- Charing Cross Hospital, London, UK
| | | | - N Asmar
- Charing Cross Hospital, London, UK
| | | | | | | | - J Senor
- Charing Cross Hospital, London, UK
| | | | - P Tantrige
- Princess Royal University Hospital, Orpington, UK
| | - A Taha
- Princess Royal University Hospital, Orpington, UK
| | - K Ballal
- Princess Royal University Hospital, Orpington, UK
| | - A Mattar
- Princess Royal University Hospital, Orpington, UK
| | - A Daadipour
- Princess Royal University Hospital, Orpington, UK
| | - K Elfergani
- Princess Royal University Hospital, Orpington, UK
| | - R Barker
- Frimley Park Hospital, Surrey, UK
| | | | | | - B J Kemp
- John Radcliffe Hospital, Oxford, UK
| | | | | | - O Y Wong
- University College Hospital, London, UK
| | - D Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - A Banaras
- University College Hospital, London, UK
| | - M Anjari
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK
| | | | | | | | | | - R E Y Zaher
- Southampton General Hospital, Southampton, UK
| | - V L Reay
- Southampton General Hospital, Southampton, UK
| | - M Banerjee
- Southampton General Hospital, Southampton, UK
| | | | - A P Oo
- Southampton General Hospital, Southampton, UK
| | - A Lo
- Addenbrooke's Hospital, Cambridge, UK
| | - P Rogers
- Addenbrooke's Hospital, Cambridge, UK
| | - T Hughes
- Cardiff and Vale University Health Board, Cardiff, UK
| | - A Marin
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Mukherjee
- Cardiff and Vale University Health Board, Cardiff, UK
| | - H Jaber
- Cardiff and Vale University Health Board, Cardiff, UK
| | - E Sanders
- Cardiff and Vale University Health Board, Cardiff, UK
| | - S Owen
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | - S Sundayi
- Watford General Hospital, Watford, UK
| | - A Bhagat
- Watford General Hospital, Watford, UK
| | - M Elsakka
- Watford General Hospital, Watford, UK
| | - O H Hashmi
- Norfolk and Norwich University Hospital, Norwich, UK
| | - M Lymbouris
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - M Arshad
- Norfolk and Norwich University Hospital, Norwich, UK
| | - I Hasan
- Norfolk and Norwich University Hospital, Norwich, UK
| | - N Singh
- Norfolk and Norwich University Hospital, Norwich, UK
| | - V Patel
- St Thomas' Hospital, London, UK
| | | | - T C Booth
- King's College Hospital, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
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Talha KM, Winscott JG, Patel V, Lemor A, Ashley KE, Campbell WF, McMullan MR, Hernandez GA. Using Arterial Recoil for Large Bore Access Closure After Impella Assist Device Removal. Crit Pathw Cardiol 2024; 23:36-38. [PMID: 37944008 DOI: 10.1097/hpc.0000000000000343] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The use of Impella assist device for high-risk percutaneous coronary interventions and cardiogenic shock has increased in the last decade and requires a large bore arterial access (LBA). However, LBA closure following Impella removal is associated with significant complications. Herein, we describe the safety and efficacy of a novel method of LBA closure using arterial recoil following Impella removal. We performed a retrospective review of electronic medical records of patients who underwent LBA closure using this method from July 1, 2018 to June 30, 2022. The procedure involves controlled downsizing of the arterial sheath from 12 French (Fr) to 6 Fr catheters with intermittent compression to allow patent hemostasis facilitated by arterial recoil. Baseline characteristics and outcomes including closure success, immediate/delayed bleeding, and access site complications were included. Of 103 patients with Impella placement, 20 (19%) underwent LBA closure with this method. Patients were predominantly male (80%) and White (55%) with a mean age of 65 ± 16 years. After downsizing of the femoral sheath to 6 Fr, 14 patients underwent manual compression, 3 patients had a 6 Fr catheter left in place to maintain access, and 3 patients underwent placement of a Perclose or Vascade device. Successful LBA closure was performed in all patients with no immediate or delayed bleeding complications. Five patients (25%) died inpatient; the deaths were unrelated to complications of Impella removal. In conclusion, LBA closure post-Impella removal with this novel method was safe and effective. Further prospective studies are needed to ascertain its comparative efficacy.
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Affiliation(s)
- Khawaja M Talha
- From the Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - John G Winscott
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Vishal Patel
- From the Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Alejandro Lemor
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Kellan E Ashley
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - William F Campbell
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Michael R McMullan
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Gabriel A Hernandez
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
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Bell CF, Bobbili P, Desai R, Gibbons DC, Drysdale M, DerSarkissian M, Patel V, Birch HJ, Lloyd EJ, Zhang A, Duh MS. Real-World Effectiveness of Sotrovimab for the Early Treatment of COVID-19: Evidence from the US National COVID Cohort Collaborative (N3C). Clin Drug Investig 2024; 44:183-198. [PMID: 38379107 PMCID: PMC10912146 DOI: 10.1007/s40261-024-01344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND AND OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has been an unprecedented healthcare crisis, one that threatened to overwhelm health systems and prompted an urgent need for early treatment options for patients with mild-to-moderate COVID-19 at high risk for progression to severe disease. Randomised clinical trials established the safety and efficacy of monoclonal antibodies (mAbs) early in the pandemic; in vitro data subsequently led to use of the mAbs being discontinued, without clear evidence on how these data were linked to outcomes. In this study, we describe and compare real-world outcomes for patients with mild-to-moderate COVID-19 at high risk for progression to severe COVID-19 treated with sotrovimab versus untreated patients. METHODS Electronic health records from the National COVID Cohort Collaborative (N3C) were used to identify US patients (aged ≥ 12 years) diagnosed with COVID-19 (positive test or ICD-10: U07.1) in an ambulatory setting (27 September 2021-30 April 2022) who met Emergency Use Authorization (EUA) high-risk criteria. Patients receiving the mAb sotrovimab within 10 days of diagnosis were assigned to the sotrovimab cohort, with the day of infusion as the index date. Untreated patients (no evidence of early mAb treatment, prophylactic mAb or oral antiviral treatment) were assigned to the untreated cohort, with an imputed index date based on the time distribution between diagnosis and sotrovimab infusion in the sotrovimab cohort. The primary endpoint was hospitalisation or death (both all-cause) within 29 days of index, reported as descriptive rate and adjusted [via inverse probability of treatment weighting (IPTW)] odds ratio (OR) and 95% confidence interval (CI). RESULTS Of nearly 2.9 million patients diagnosed with COVID-19 during the analysis period, 4992 met the criteria for the sotrovimab cohort, and 541,325 were included in the untreated cohort. Before weighting, significant differences were noted between the cohorts; for example, patients in the sotrovimab cohort were older (60 years versus 54 years), were more likely to be white (85% versus 75%) and met more EUA criteria (mean 3.1 versus 2.2) versus the untreated cohort. The proportions of patients with 29-day hospitalisation or death were 3.5% (176/4992) and 4.5% (24,163/541,325) in the sotrovimab and untreated cohorts, respectively (unadjusted OR: 0.78; 95% CI: 0.67, 0.91; p = 0.001). In adjusted analysis, sotrovimab was associated with a 25% reduction in the odds of hospitalisation or death compared with the untreated cohort (IPTW-adjusted OR: 0.75; 95% CI: 0.61, 0.92; p = 0.005). CONCLUSIONS Sotrovimab demonstrated clinical effectiveness in preventing severe outcomes (hospitalisation, mortality) in the period 27 September 2021-30 April 2022, which included Delta and Omicron BA.1 variants and an early surge of Omicron BA.2 variant.
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Affiliation(s)
- Christopher F Bell
- GSK, Research Triangle Park, 410 Blackwell Street, Durham, NC, 27701, USA.
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Middlebrooks EH, Tipton PW, Greco E, Okromelidze L, Patel V, Wszolek ZK, Zhou X, Tao S, Westerhold EM, Straub S, Uitti RJ, Sandhu SJS, Quiñones-Hinojosa A, Grewal SS. Enhancing outcomes in deep brain stimulation: a comparative study of direct targeting using 7T versus 3T MRI. J Neurosurg 2024:1-8. [PMID: 38394660 DOI: 10.3171/2023.12.jns232473] [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: 11/02/2023] [Accepted: 12/14/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVE The aim of this study was to compare outcomes of direct targeting in deep brain stimulation (DBS) for essential tremor using 7T MRI versus 3T MRI. The authors hypothesized that 7T MRI direct targeting would be noninferior to 3T MRI in early tremor outcomes. METHODS A retrospective study was conducted on patients undergoing unilateral thalamic DBS for essential tremor between 2021 and 2023. Two matched cohorts were assessed, one using 7T MRI and the other using 3T MRI for surgical planning. The primary endpoint was the percentage improvement in the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) scores. Additionally, the authors assessed optimized programming settings and variance in electrode position on postoperative imaging. Demographic and clinical data were compared using the nonparametric Mann-Whitney U-test. The squared Euclidean distance of each contact from the group mean centroid was calculated and averaged across the entire cohort to provide the variance (i.e., the mean squared distance) of electrode contact position. RESULTS A total of 34 patients were analyzed, with 17 in each cohort. There were no significant differences in demographic information or mean surgical dates between the groups. There were no differences in intraoperative target repositioning or adverse events. The 7T group had a significantly greater TRS improvement than the 3T group (64.9% ± 11.4% vs 50.9% ± 16.4%, p = 0.004). Patients in the 7T cohort also had a lower mean stimulation current compared with those in the 3T cohort (2.0 ± 0.8 mA vs 2.7 ± 0.9 mA, p = 0.01). Image evaluation revealed that although the mean electrode position was comparable between 7T and 3T, the 7T electrode positioning was more clustered, indicating a lower variance in the final electrode location. The mean Euclidean distance between the individual electrode tips and the group centroid was significantly less at 7T than at 3T (1.82 ± 0.68 mm vs 2.75 ± 0.81 mm, p = 0.001). CONCLUSIONS Despite concerns for increased artifacts and distortions at 7T, the authors show that these effects can be mitigated with an appropriate workflow, leading to improved surgical outcomes with direct targeting using 7T MRI. Their results suggest similar accuracy but greater precision in targeting with 7T MRI compared with 3T MRI, resulting in lower stimulation currents and improved tremor reduction. Future studies are needed to assess outcomes related to 7T MRI in targeting other subcortical structures.
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Patel V, Wang A, Monk AP, Schneider MTY. Enhancing Knee MR Image Clarity through Image Domain Super-Resolution Reconstruction. Bioengineering (Basel) 2024; 11:186. [PMID: 38391672 DOI: 10.3390/bioengineering11020186] [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: 01/16/2024] [Revised: 02/03/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
This study introduces a hybrid analytical super-resolution (SR) pipeline aimed at enhancing the resolution of medical magnetic resonance imaging (MRI) scans. The primary objective is to overcome the limitations of clinical MRI resolution without the need for additional expensive hardware. The proposed pipeline involves three key steps: pre-processing to re-slice and register the image stacks; SR reconstruction to combine information from three orthogonal image stacks to generate a high-resolution image stack; and post-processing using an artefact reduction convolutional neural network (ARCNN) to reduce the block artefacts introduced during SR reconstruction. The workflow was validated on a dataset of six knee MRIs obtained at high resolution using various sequences. Quantitative analysis of the method revealed promising results, showing an average mean error of 1.40 ± 2.22% in voxel intensities between the SR denoised images and the original high-resolution images. Qualitatively, the method improved out-of-plane resolution while preserving in-plane image quality. The hybrid SR pipeline also displayed robustness across different MRI sequences, demonstrating potential for clinical application in orthopaedics and beyond. Although computationally intensive, this method offers a viable alternative to costly hardware upgrades and holds promise for improving diagnostic accuracy and generating more anatomically accurate models of the human body.
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Affiliation(s)
- Vishal Patel
- Auckland Bioengineering Institute, The University of Auckland, Auckland 1010, New Zealand
| | - Alan Wang
- Auckland Bioengineering Institute, The University of Auckland, Auckland 1010, New Zealand
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1010, New Zealand
| | - Andrew Paul Monk
- Auckland Bioengineering Institute, The University of Auckland, Auckland 1010, New Zealand
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12
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Wang PF, Yang Y, Patel V, Neiner A, Kharasch ED. Natural Products Inhibition of Cytochrome P450 2B6 Activity and Methadone Metabolism. Drug Metab Dispos 2024; 52:252-265. [PMID: 38135504 PMCID: PMC10877711 DOI: 10.1124/dmd.123.001578] [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] [Received: 10/18/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023] Open
Abstract
Methadone is cleared predominately by hepatic cytochrome P450 (CYP) 2B6-catalyzed metabolism to inactive metabolites. CYP2B6 also catalyzes the metabolism of several other drugs. Methadone and CYP2B6 are susceptible to pharmacokinetic drug-drug interactions. Use of natural products such as herbals and other botanicals is substantial and growing, and concomitant use of prescription medicines and non-prescription herbals is common and may result in interactions, often precipitated by CYP inhibition. Little is known about herbal product effects on CYP2B6 activity, and CYP2B6-catalyzed methadone metabolism. We screened a family of natural product compounds used in traditional medicines, herbal teas, and synthetic analogs of compounds found in plants, including kavalactones, flavokavains, chalcones and gambogic acid, for inhibition of expressed CYP2B6 activity and specifically inhibition of CYP2B6-mediated methadone metabolism. An initial screen evaluated inhibition of CYP2B6-catalyzed 7-ethoxy-4-(trifluoromethyl) coumarin O-deethylation. Hits were further evaluated for inhibition of racemic methadone metabolism, including mechanism of inhibition and kinetic constants. In order of decreasing potency, the most effective inhibitors of methadone metabolism were dihydromethysticin (competitive, K i 0.074 µM), gambogic acid (noncompetitive, K i 6 µM), and 2,2'-dihydroxychalcone (noncompetitive, K i 16 µM). Molecular modeling of CYP2B6-methadone and inhibitor binding showed substrate and inhibitor binding position and orientation and their interactions with CYP2B6 residues. These results show that CYP2B6 and CYP2B6-catalyzed methadone metabolism are inhibited by certain natural products, at concentrations which may be clinically relevant. SIGNIFICANCE STATEMENT: This investigation identified several natural product constituents which inhibit in vitro human recombinant CYP2B6 and CYP2B6-catalyzed N-demethylation of the opioid methadone. The most potent inhibitors (K i) were dihydromethysticin (0.074 µM), gambogic acid (6 µM) and 2,2'-dihydroxychalcone (16 µM). Molecular modeling of ligand interactions with CYP2B6 found that dihydromethysticin and 2,2'-dihydroxychalcone bound at the active site, while gambogic acid interacted with an allosteric site on the CYP2B6 surface. Natural product constituents may inhibit CYP2B6 and methadone metabolism at clinically relevant concentrations.
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Affiliation(s)
- Pan-Fen Wang
- Department of Anesthesiology, Duke University, Durham, North Carolina (P.-F.W., E.D.K.) and Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri (Y.Y., V.P., A.N.)
| | - Yanming Yang
- Department of Anesthesiology, Duke University, Durham, North Carolina (P.-F.W., E.D.K.) and Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri (Y.Y., V.P., A.N.)
| | - Vishal Patel
- Department of Anesthesiology, Duke University, Durham, North Carolina (P.-F.W., E.D.K.) and Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri (Y.Y., V.P., A.N.)
| | - Alicia Neiner
- Department of Anesthesiology, Duke University, Durham, North Carolina (P.-F.W., E.D.K.) and Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri (Y.Y., V.P., A.N.)
| | - Evan D Kharasch
- Department of Anesthesiology, Duke University, Durham, North Carolina (P.-F.W., E.D.K.) and Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri (Y.Y., V.P., A.N.)
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13
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Middlebrooks EH, Patel V, Zhou X, Straub S, Murray JV, Agarwal AK, Okromelidze L, Singh RB, Lopez Chiriboga AS, Westerhold EM, Gupta V, Sandhu SJS, Marin Collazo IV, Tao S. 7 T Lesion-Attenuated Magnetization-Prepared Gradient Echo Acquisition for Detection of Posterior Fossa Demyelinating Lesions in Multiple Sclerosis. Invest Radiol 2024:00004424-990000000-00187. [PMID: 38193790 DOI: 10.1097/rli.0000000000001050] [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: 01/10/2024]
Abstract
OBJECTIVES Detection of infratentorial demyelinating lesions in multiple sclerosis (MS) presents a challenge in magnetic resonance imaging (MRI), a difficulty that is further heightened in 7 T MRI. This study aimed to assess the efficacy of a novel MRI approach, lesion-attenuated magnetization-prepared gradient echo acquisition (LAMA), for detecting demyelinating lesions within the posterior fossa and upper cervical spine on 7 T MRI and contrast its performance with conventional double-inversion recovery (DIR) and T2-weighted turbo spin echo sequences. MATERIALS AND METHODS We conducted a retrospective cross-sectional study in 42 patients with a confirmed diagnosis of MS. All patients had 7 T MRI that incorporated LAMA, 3D DIR, and 2D T2-weighted turbo spin echo sequences. Three readers assessed lesion count in the brainstem, cerebellum, and upper cervical spinal cord using both DIR and T2-weighted images in one session. In a separate session, LAMA was analyzed alone. Contrast-to-noise ratio was also compared between LAMA and the conventional sequences. Lesion counts between methods were assessed using nonparametric Wilcoxon signed rank test. Interrater agreement in lesion detection was estimated by intraclass correlation coefficients. RESULTS LAMA identified a significantly greater number of lesions than DIR + T2 (mean 6.4 vs 3.0; P < 0.001). LAMA also exhibited better interrater agreement (intraclass correlation coefficient [95% confidence interval], 0.75 [0.41-0.88] vs 0.61 [0.35-0.78]). The contrast-to-noise ratio for LAMA (3.7 ± 0.9) significantly exceeded that of DIR (1.94 ± 0.7) and T2 (1.2 ± 0.7) (all P's < 0.001). In cases with no lesions detected using DIR + T2, at least 1 lesion was identified in 83.3% with LAMA. Across all analyzed brain regions, LAMA consistently detected more lesions than DIR + T2. CONCLUSIONS LAMA significantly improves the detection of infratentorial demyelinating lesions in MS patients compared with traditional methods. Integrating LAMA with standard magnetization-prepared 2 rapid acquisition gradient echo acquisition provides a valuable tool for accurately characterizing the extent of MS disease.
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Affiliation(s)
- Erik H Middlebrooks
- From the Department of Radiology, Mayo Clinic, Jacksonville, FL (E.H.M., V.P., X.Z., S.S., J.V.M.J., A.K.A., L.O., R.B.S., E.M.W., V.G., S.J.S.S., S.T.); and Department of Neurology, Mayo Clinic, Jacksonville, FL (A.S.L.C., I.V.M.)
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14
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Lakhani DA, Zhou X, Tao S, Patel V, Wen S, Okromelidze L, Greco E, Lin C, Westerhold EM, Straub S, Wszolek ZK, Tipton PW, Uitti RJ, Grewal SS, Middlebrooks EH. Diagnostic utility of 7T neuromelanin imaging of the substantia nigra in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:13. [PMID: 38191546 PMCID: PMC10774294 DOI: 10.1038/s41531-024-00631-3] [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: 08/30/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024] Open
Abstract
Parkinson's disease (PD) is a prevalent neurodegenerative disorder that presents a diagnostic challenge due to symptom overlap with other disorders. Neuromelanin (NM) imaging is a promising biomarker for PD, but adoption has been limited, in part due to subpar performance at standard MRI field strengths. We aimed to evaluate the diagnostic utility of ultra-high field 7T NM-sensitive imaging in the diagnosis of PD versus controls and essential tremor (ET), as well as NM differences among PD subtypes. A retrospective case-control study was conducted including PD patients, ET patients, and controls. 7T NM-sensitive 3D-GRE was acquired, and substantia nigra pars compacta (SNpc) volumes, contrast ratios, and asymmetry indices were calculated. Statistical analyses, including general linear models and ROC curves, were employed. Twenty-one PD patients, 13 ET patients, and 18 controls were assessed. PD patients exhibited significantly lower SNpc volumes compared to non-PD subjects. SNpc total volume showed 100% sensitivity and 96.8% specificity (AUC = 0.998) for differentiating PD from non-PD and 100% sensitivity and 95.2% specificity (AUC = 0.996) in differentiating PD from ET. Contrast ratio was not significantly different between PD and non-PD groups (p = 0.07). There was also significantly higher asymmetry index in SNpc volume in PD compared to non-PD cohorts (p < 0.001). NM signal loss in PD predominantly involved the inferior, posterior, and lateral aspects of SNpc. Akinetic-rigid subtype showed more significant NM signal loss compared to tremor dominant subtype (p < 0.001). 7T NM imaging demonstrates potential as a diagnostic tool for PD, including potential distinction between subtypes, allowing improved understanding of disease progression and subtype-related characteristics.
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Affiliation(s)
- Dhairya A Lakhani
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Xiangzhi Zhou
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Shengzhen Tao
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Vishal Patel
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Sijin Wen
- Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | | | - Elena Greco
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Sina Straub
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA.
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
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15
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Purtle B, Wagner J, Zarker A, Patel V, Aguilar D. Heart Failure in a Young Adult with a Fine-Lubinsky Syndrome: An Unknown Comorbidity. Case Rep Cardiol 2024; 2024:5596010. [PMID: 38205069 PMCID: PMC10776188 DOI: 10.1155/2024/5596010] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/30/2023] [Accepted: 11/18/2023] [Indexed: 01/12/2024] Open
Abstract
The Fine-Lubinsky syndrome (FLS) is a rare congenital disorder. Heart failure has not been described in young adults with this condition. Here, we report the first case of heart failure in a young adult patient with FLS. This finding highlights the need for further investigation into cardiac complications in this illness.
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Affiliation(s)
- Blake Purtle
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX, USA
| | - Jason Wagner
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX, USA
| | - Andrew Zarker
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX, USA
| | - Vishal Patel
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX, USA
| | - David Aguilar
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX, USA
- Cardiovascular Medicine, Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX, USA
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16
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Patel V, Mill J, Okonkwo OC, Salamat S, Li L, Raife T. Global Energy Metabolism Deficit in Alzheimer Disease Brain. J Prev Alzheimers Dis 2024; 11:171-178. [PMID: 38230730 DOI: 10.14283/jpad.2023.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND The understanding of Alzheimer's disease (AD) has been dominated by the amyloid hypothesis. However, therapies targeting beta-amyloid have largely failed, generating interest in other potential pathogenic factors including energy metabolism. OBJECTIVES To interrogate canonical energy metabolism pathways from human prefrontal cortical tissue samples obtained from necropsy comparing AD and control. DESIGN, SETTING, AND PARTICIPANTS Postmortem pre-frontal cortical tissue from 10 subjects histologically diagnosed with AD and 10 control (CTRL) subjects was subjected to untargeted metabolomics to interrogate energy metabolism pathways. The samples were matched by age, sex, and post-mortem interval. Metabolite Measurements: Untargeted metabolomics analyses were via Metabolon®. RESULTS Glucose-derived energy metabolites in the glycolytic and pentose phosphate pathway and the ketone body β-hydroxybutyrate were uniformly decreased in AD brain vs. CTRL brain. CONCLUSION This pilot study aimed to identify energy metabolism abnormalities using untargeted brain metabolomics in two independent subject cohorts. Our study revealed a pattern of global energy deficit in AD brain, supporting a growing body of evidence of deficient energy metabolism in AD.
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Affiliation(s)
- V Patel
- Viharkumar Patel, University of California Davis Department of Pathology, 4400 V Street Suite 1114, Sacramento, CA 95817, USA, E-mail:
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17
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Boyd AM, Sue C, Khandoobhai A, Vinson B, Shaikh H, Sorenson S, Patel V, Snyder B, Bondarenka C, Koukounas Y, Earl M, Jenkins M. Evaluation of oncology infusion pharmacy practices: A nationwide survey. J Oncol Pharm Pract 2024; 30:127-141. [PMID: 37122190 DOI: 10.1177/10781552231170358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE Oncology care continues to evolve at a rapid pace including provision of infusion-based care. There is currently a lack of robust metrics around oncology infusion centers and pharmacy practice. The workgroup completed a nationwide survey to learn about oncology-based infusion pharmacy services offered. The objective was to highlight consistent, measureable oncology-based infusion pharmacy metrics that will provide a foundation to describe overall productivity including emphasis on high patient-safety standards. METHODS A nationwide survey was developed via a workgroup within the Vizient Pharmacy Cancer Care Group beginning in April 2019 and conducted electronically via the Vizient Pharmacy Network from September to November 2020. The survey was designed to capture a number of key metrics related to oncology-based infusion pharmacy services. RESULTS Forty-one sites responded to the survey. Responses highlighted hours of operation (median = 11.5), number of infusion chairs (median = 45). Staffing metrics included 7.1 pharmacist full-time equivalent (FTE) and 7.6 technician FTE per week. 80.5% of sites had cleanrooms and 95.1% reported both hazardous and nonhazardous compounding hoods. 68.3% of sites reported using intravenous (IV) technology, 50.0% measured turnaround time, and 31.4% prepared treatment medications in advance. CONCLUSION There was variability among oncology infusion pharmacy practices in regard to survey responses among sites. The survey results highlight the need for standardization of established productivity metrics across oncology infusion pharmacies in order to improve efficiency and contain costs in the changing oncology landscape. The survey provides insight into oncology infusion pharmacy practices nationwide and provides information for pharmacy leaders to help guide their practices.
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Affiliation(s)
- A M Boyd
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - C Sue
- Department of Pharmacy, UC Health, Cincinnati, OH, USA
| | - A Khandoobhai
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - B Vinson
- Department of Pharmacy, Cedars-Sinai, Los Angeles, CA, USA
| | - H Shaikh
- Department of Pharmacy, University Health, Kansas City, MO, USA
| | - S Sorenson
- Department of Pharmacy, University of Iowa Health Care, Iowa City, IA, USA
| | - V Patel
- Department of Pharmacy, Cedars-Sinai, Los Angeles, CA, USA
| | - B Snyder
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
- Bristol-Meyers Squibb Company, New York, NY, USA
| | - C Bondarenka
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Y Koukounas
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
- Novartis, Basel, Switzerland
| | - M Earl
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
- Seagen, Bothell, WA, USA
| | - M Jenkins
- Department of Pharmacy Services, UVA Health, Charlottesville, VA, USA
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18
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Okromelidze L, Patel V, Singh RB, Lopez Chiriboga AS, Tao S, Zhou X, Straub S, Westerhold EM, Gupta V, Agarwal AK, Murray JV, Desai A, Sandhu SJS, Marin Collazo IV, Middlebrooks EH. Central Vein Sign in Multiple Sclerosis: A Comparison Study of the Diagnostic Performance of 3T versus 7T MRI. AJNR Am J Neuroradiol 2023; 45:76-81. [PMID: 38164557 PMCID: PMC10756573 DOI: 10.3174/ajnr.a8083] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND PURPOSE An early and accurate diagnosis of multiple sclerosis remains challenging in clinical neurology. Established diagnostic methods have less than desirable sensitivity and specificity. An accurate, noninvasive diagnostic test for MS could have a major impact on diagnostic criteria. We compared the frequency of detection of the central vein sign (CVS) in white matter lesions of MS and controls on 7T T2*-weighted and SWI to 3T SWI. Additionally, we assessed the diagnostic performance of 7T T2*, 7T SWI, and 3T SWI for MS. MATERIALS AND METHODS A retrospective case-control study was performed of patients with MS having both 7T MRI and 3T MRI. A control group of patients without MS was selected. Diagnosis of MS was established by board-certified neurologists with fellowship training in autoimmune neurology in line with the 2017 McDonald criteria. Percentage of lesions with a CVS was blindly measured for each technique. Diagnostic performance was computed by sensitivity, specificity, and positive and negative likelihood ratios (LRs). RESULTS Sixty-one patients with MS (903 lesions) and 39 controls (1088 lesions) were included. 7T T2* showed significantly more CVS (87%) than both 7T SWI (73%) and 3T SWI (31%) (all P < .001). CVS was identified in the control group in ≤6% of lesions on all sequences. Using a threshold of >40% of lesions with CVS on 7T T2* and >15% on 7T SWI, both sequences had an accuracy = 100%, sensitivity = 100%, specificity = 100%, infinite positive LR, and zero negative LR. Using an optimal threshold of >12%, 3T SWI had an accuracy = 96.0%, sensitivity = 93.4%, specificity = 100%, infinite positive LR, and negative LR = 0.066. CONCLUSIONS 7T MRI had 100% sensitivity and specificity for the diagnosis of MS and is superior to 3T. Future revisions to MS diagnostic criteria may consider recommendations for 7T MRI and inclusion of CVS as a biomarker.
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Affiliation(s)
- Lela Okromelidze
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Vishal Patel
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Rahul B Singh
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | | | - Shengzhen Tao
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Xiangzhi Zhou
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Sina Straub
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Erin M Westerhold
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Vivek Gupta
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Amit K Agarwal
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - John V Murray
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Amit Desai
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S J S Sandhu
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | | | - Erik H Middlebrooks
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
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El Shatanofy M, Thakkar P, Patel V, Joshi A, Goodman J, Siegel R, Haroun F, Ojong-Ntui M, Goyal S, Bauman J, Rao YJ. Intensified Adjuvant Treatment for High-Risk Resected Cutaneous Angiosarcoma of the Head and Neck. Otolaryngol Head Neck Surg 2023; 169:1225-1233. [PMID: 37464928 DOI: 10.1002/ohn.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/10/2023] [Accepted: 05/20/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Previous studies have highlighted the poor survival of patients with cutaneous angiosarcoma of the head and neck. Therapeutic options are limited, and effective treatment strategies are yet to be discovered. The objective of this study is to evaluate overall survival following intensified adjuvant treatment for high-risk resected angiosarcoma of the head and neck. STUDY DESIGN Retrospective observational. SETTING National Cancer Database (NCDB). METHODS Patients diagnosed with nonmetastatic cutaneous angiosarcoma of the head and neck from 2004 to 2016 were identified by NCDB. We retrospectively compared demographics and overall survival between patients who received surgery and radiation therapy (SR) and patients who received surgery and chemoradiation (SRC). The χ2 test, Kaplan-Meier method, and Cox regression models were used to analyze data. RESULTS A total of 249 patients were identified, of which 79.5% were treated with surgery and radiation alone and 20.5% were treated with surgery and chemoradiation. The addition of chemotherapy, regardless of the sequence of administration, was not associated with significantly higher overall survival. Factors associated with worse survival in both groups included positive nodal status and positive margins. Patients with positive nodes had higher overall survival with radiation doses >50.4 Gy compared to ≤50.4 Gy (hazard ratio: 2.93, confidence interval: 1.60-5.36, p < 0.001). CONCLUSION Adjuvant chemotherapy was not significantly associated with higher overall survival for resected nonmetastatic angiosarcoma of the head and neck. Higher radiation doses appear to be prognostic for high-risk diseases.
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Affiliation(s)
- Muhammad El Shatanofy
- Department of Otolaryngology, The George Washington University Hospital, Washington, District of Columbia, USA
- Department of Otolaryngology, University of Miami Hospital, Miami, Florida, USA
| | - Punam Thakkar
- Department of Otolaryngology, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Vishal Patel
- Department of Dermatology, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Arjun Joshi
- Department of Otolaryngology, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Joseph Goodman
- Department of Otolaryngology, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Robert Siegel
- Department of Hematology Oncology, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Faysal Haroun
- Department of Hematology Oncology, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Martin Ojong-Ntui
- Department of Radiation Oncology, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Sharad Goyal
- Department of Radiation Oncology, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Julie Bauman
- Cancer Center, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Yuan James Rao
- Department of Radiation Oncology, The George Washington University Hospital, Washington, District of Columbia, USA
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Humbert-Vidan L, Patel V, King AP, Guerrero Urbano T. Interpretability of a Deep Learning-Based Prediction Model for Mandibular Osteoradionecrosis. Int J Radiat Oncol Biol Phys 2023; 117:e468-e469. [PMID: 37785491 DOI: 10.1016/j.ijrobp.2023.06.1673] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The development of radiation-induced toxicities is a multifactorial process. Existing DVH-based prediction models use traditional multivariate analysis to combine all the potential risk factors. Recently, deep learning (DL) has been proposed for predicting mandibular osteoradionecrosis (ORN) directly from 3D dose distribution maps [1]. However, with this approach, incorporating non-imaging data such as potential risk factors presents challenges. We investigate the use of DL-based multimodality fusion for the purpose of radiation-induced ORN toxicity prediction. MATERIALS/METHODS This study explores early and late fusion strategies for combining 3D radiation dose distribution maps and clinical and demographic variables in the prediction of mandibular ORN incidence in head and neck cancer patients treated with radiotherapy. The results are compared to single-modality predictions with a random forest (RF) trained only on clinical variables and a 3D DenseNet40 trained on dose maps alone. We investigate two different fusion approaches. In the first, the image features extracted from the radiation dose maps using a 3D DenseNet40 were concatenated with the clinical variables into one single vector using a type II early fusion strategy. The combined feature vector was input into a fully connected layer for classification of ORN vs. controls. A final softmax activation layer was added to obtain the class predicted probabilities. The second approach used a late fusion strategy, in which the outputs from the 3D DenseNet40 and the RF model were combined by averaging the predicted classification probabilities for each of the two classes (ORN and no ORN) to obtain the final class decision on a case-by-case basis. RESULTS The AUROC values obtained for the late and early fusion models and the single-modality 3D DenseNet40 and RF models were 0.70, 0.68, 0.69 and 0.60, respectively. The highest AUC ROC was observed with the late fusion approach, which was statistically significantly different to that of the RF single-modality model with a significance level of 0.05. However, after Bonferroni correction (Altman 1999) for multiple comparisons was applied, resulting in a corrected significance level of 0.05/6 = 0.008 for each comparison, no statistically significant difference was observed between any of the models' AUROC values. This is most likely due to the lack of discriminative contribution observed from clinical variables, which on their own resulted in a poorly predictive RF model. CONCLUSION To our knowledge, no previous work has been published on the use of multimodal fusion DL methods to combine dose distribution maps and clinical variables in the prediction of mandibular ORN. Although non-conclusive results were obtained, this study demonstrates the potential of DL in the prediction of the multifactorial side effects resulting from radiotherapy treatments. [1] Humbert-Vidan L et al. Prediction of Mandibular ORN Incidence from 3D Radiation Dose Distribution Maps Using DL (2022).
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Affiliation(s)
- L Humbert-Vidan
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - V Patel
- Department of Oral Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A P King
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - T Guerrero Urbano
- King's College London, London, United Kingdom; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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21
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Driever EG, Muntz I, Patel V, Adelmeijer J, Bernal W, Koenderink GH, Lisman T. Fibrin clots from patients with acute-on-chronic liver failure are weaker than those from healthy individuals and patients with sepsis without underlying liver disease. J Thromb Haemost 2023; 21:2747-2758. [PMID: 37336436 DOI: 10.1016/j.jtha.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/09/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Previous studies identified decreased clot permeability, without differences in fibrin fiber density in clots, from patients with cirrhosis compared with those from healthy controls (HCs). Fibrinogen hypersialylation could be the reason for this discrepancy. OBJECTIVES The aim of this work was to study mechanical properties of clots and reassess clot permeability in relation to hypersialylation in patients with stable cirrhosis, acute decompensation, and acute-on-chronic liver failure (ACLF). Sepsis patients without liver disease were included to distinguish between liver-specific and inflammation-driven phenotypes. METHODS Pooled plasma was used for rheology and permeability experiments. Permeability was assessed with compression using a rheometer and by liquid permeation. Purified fibrinogen treated with neuraminidase was used to study the effects of fibrinogen hypersialylation on liquid permeation. RESULTS Mechanical properties of clots from patients with stable cirrhosis and acute decompensation were similar to those of clots from HCs, but clots from patients with ACLF were softer and ruptured at lower shear stress. Clots from sepsis patients without liver disease were stiffer than those from the other groups, but this effect disappeared after adjusting for increased plasma fibrinogen concentrations. Permeability was similar between clots under compression from HCs and clots under compression from patients but decreased with increasing disease severity in liquid permeation. Removal of fibrinogen sialic acid residues increased permeability more in patients than in controls. CONCLUSION Clots from patients with ACLF have weak mechanical properties despite unaltered fibrin fiber density. Previous liquid permeation experiments may have erroneously concluded that clots from patients with ACLF are prothrombotic as fibrinogen hypersialylation leads to underestimation of clot permeability in this setting, presumably due to enhanced water retention.
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Affiliation(s)
- Ellen G Driever
- Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Iain Muntz
- Department of Bionanoscience, Kavli Institute of Nanoscience, Delft University of Technology, Delft, the Netherlands
| | - Vishal Patel
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jelle Adelmeijer
- Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - William Bernal
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gijsje H Koenderink
- Department of Bionanoscience, Kavli Institute of Nanoscience, Delft University of Technology, Delft, the Netherlands.
| | - Ton Lisman
- Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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22
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Sharma V, Jain A, Patel V, Pandya H, Choudhari A. Outcomes of coronary artery bypass grafting based on myocardial perfusion imaging. Kardiochir Torakochirurgia Pol 2023; 20:161-166. [PMID: 37937169 PMCID: PMC10626410 DOI: 10.5114/kitp.2023.132062] [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] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/08/2023] [Indexed: 11/09/2023]
Abstract
Introduction Coronary artery disease (CAD) is the foremost single cause of mortality and loss of disability-adjusted life years globally and a large percentage of this burden is found in low and middle income countries, with the treatment strategies based on revascularisation, based on studies that have shown that on revascularisation of viable myocardium there is an improvement of function over a period of time. Aim To evaluate the utilization of myocardial perfusion imaging (MPI) for identifying viable myocardium and assessing the improvement. Material and methods This prospective observational study was conducted in patients having CAD planned for coronary artery bypass grafting. The patients were evaluated using 2D ECHO and MPI preoperatively and postoperatively after 1 year. Results Mean ejection fraction preoperatively was 40.6 ±9.72% and postoperatively it improved to 41.32 ±10.64% and ejection fraction was calculated using MPI and an average improvement from 35.98 ±12.72% to 45.51 ±12.61% (p ≤ 0.0001). Summed rest score was calculated and an improvement was noted from 24.28 ±8.47 to 18.02 ±8.75 (p ≤ 0.0001). Total perfusion deficit was calculated and was found to have reduced from 32.44 ±11.98 to 25.61 ±12.23 (p ≤ 0.0001). Conclusions MPI was able to accurately assess the improvement, which correlated not only with the 2D echocardiography data but also with the clinical wellbeing of the patients. Being a non-invasive, quick procedure, it should be added to the arsenal of the cardiac surgeon for evaluation of patients with diffuse diseases, low ejection fractions, patients who might generally be considered inoperable.
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Affiliation(s)
- Vishesh Sharma
- Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, (Affiliated to B.J. Medical College), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Anil Jain
- Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, (Affiliated to B.J. Medical College), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Vishal Patel
- Department of Nuclear Medicine, U.N. Mehta Institute of Cardiology and Research Center, (Affiliated to B.J. Medical College), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Himani Pandya
- Department of Research, U.N. Mehta Institute of Cardiology and Research Center, (Affiliated to B.J. Medical College), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Amit Choudhari
- Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center, (Affiliated to B.J. Medical College), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
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Middlebrooks EH, Tao S, Zhou X, Greco E, Westerhold EM, Tipton PW, Quinones-Hinojosa A, Grewal SS, Patel V. Synthetic Inversion Image Generation using MP2RAGE T1 Mapping for Surgical Targeting in Deep Brain Stimulation and Lesioning. Stereotact Funct Neurosurg 2023; 101:326-331. [PMID: 37607507 DOI: 10.1159/000533259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Advances in MRI technology have increased interest in direct targeting for deep brain stimulation (DBS). Various imaging sequences have been shown to provide increased contrast of numerous common DBS targets, such as T1-weighted, Fast Gray Matter Acquisition T1 Inversion Recovery (FGATIR), gray matter nulled, and Edge-Enhancing Gradient Echo (EDGE); however, the continual increase in the number of necessary sequences has led to an increase in imaging time, which is undesirable. Additionally, carefully timed inversion pulses can often lead to less-than-ideal contrast in some subjects, particularly in ultra-high field MRI, where B1+ field inhomogeneity can lead to substantial contrast variation. OBJECTIVES This study proposes using 3D MP2RAGE-based T1 maps to retrospectively synthesize images of any desired inversion time, including T1-weighted, FGATIR, and EDGE contrasts, to visualize specific DBS targets at both 3T and 7T. METHOD First, a systematic sequence optimization framework was applied to optimize MP2RAGE T1 mapping sequence parameters for the purpose of DBS planning. Next, we show that synthetic inversion-time images can be generated through a mathematical transformation of the T1 maps. The sequence was then applied to patients undergoing preoperative planning for DBS at 3T and 7T to generate synthetic contrasts used in surgical planning. RESULTS We show that synthetic image contrasts can be generated across a full range of inversion times at 3T and 7T, including commonly used sequences for DBS targeting, such as T1-weighted, FGATIR, and EDGE. Acquisition through a single sequence shortens scan time compared to acquiring the sequences independently without affecting image quality or contrast. CONCLUSIONS The generation of synthetic images for DBS targeting allows faster acquisition of many key sequences, as well as the ability to optimize contrast properties post-acquisition to account for the variable B1+ effects present in ultra-high field MRI. The proposed approach has the potential to reduce imaging time and improve the accuracy of DBS targeting at 1.5T, 3T, and 7T.
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Affiliation(s)
- Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Shengzhen Tao
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Xiangzhi Zhou
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Elena Greco
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Philip W Tipton
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Vishal Patel
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
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Sheth F, Shah J, Jain D, Shah S, Patel H, Patel K, Solanki DI, Iyer AS, Menghani B, Mhatre P, Mehta S, Bajaj S, Patel V, Pandya M, Dhami D, Patel D, Sheth J, Sheth H. Comparative yield of molecular diagnostic algorithms for autism spectrum disorder diagnosis in India: evidence supporting whole exome sequencing as first tier test. BMC Neurol 2023; 23:292. [PMID: 37543562 PMCID: PMC10403833 DOI: 10.1186/s12883-023-03341-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/21/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) affects 1 in 100 children globally with a rapidly increasing prevalence. To the best of our knowledge, no data exists on the genetic architecture of ASD in India. This study aimed to identify the genetic architecture of ASD in India and to assess the use of whole exome sequencing (WES) as a first-tier test instead of chromosomal microarray (CMA) for genetic diagnosis. METHODS Between 2020 and 2022, 101 patient-parent trios of Indian origin diagnosed with ASD according to the Diagnostic and Statistical Manual, 5th edition, were recruited. All probands underwent a sequential genetic testing pathway consisting of karyotyping, Fragile-X testing (in male probands only), CMA and WES. Candidate variant validation and parental segregation analysis was performed using orthogonal methods. RESULTS Of 101 trios, no probands were identified with a gross chromosomal anomaly or Fragile-X. Three (2.9%) and 30 (29.7%) trios received a confirmed genetic diagnosis from CMA and WES, respectively. Amongst diagnosis from WES, SNVs were detected in 27 cases (90%) and CNVs in 3 cases (10%), including the 3 CNVs detected from CMA. Segregation analysis showed 66.6% (n = 3 for CNVs and n = 17 for SNVs) and 16.6% (n = 5) of the cases had de novo and recessive variants respectively, which is in concordance with the distribution of variant types and mode of inheritance observed in ASD patients of non-Hispanic white/ European ethnicity. MECP2 gene was the most recurrently mutated gene (n = 6; 20%) in the present cohort. Majority of the affected genes identified in the study cohort are involved in synaptic formation, transcription and its regulation, ubiquitination and chromatin remodeling. CONCLUSIONS Our study suggests de novo variants as a major cause of ASD in the Indian population, with Rett syndrome as the most commonly detected disorder. Furthermore, we provide evidence of a significant difference in the diagnostic yield between CMA (3%) and WES (30%) which supports the implementation of WES as a first-tier test for genetic diagnosis of ASD in India.
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Affiliation(s)
- Frenny Sheth
- FRIGE's Institute of Human Genetics, Ahmedabad, India.
| | - Jhanvi Shah
- FRIGE's Institute of Human Genetics, Ahmedabad, India
| | - Deepika Jain
- Shishu Child Development and Early Intervention Centre, Ahmedabad, India
| | - Siddharth Shah
- Royal Institute of Child Neurosciences, Ahmedabad, India
| | | | - Ketan Patel
- Specialty Homeopathic Clinic, Ahmedabad, India
| | | | | | - Bhargavi Menghani
- Children's Institute for Development and Advancement Centre, Vadodara, India
| | - Priti Mhatre
- Tender Kinds Centre for Child Development, Navi Mumbai, India
| | - Sanjiv Mehta
- Royal Institute of Child Neurosciences, Ahmedabad, India
| | | | - Vishal Patel
- Little Brain Pediatric Neurocare Centre, Vadodara, India
| | | | - Deepak Dhami
- Axon Child Neurology and Epilepsy Centre, Rajkot, India
| | - Darshan Patel
- Charotar Institute of Paramedical Sciences, Charotar University of Science and Technology, Changa, India
| | - Jayesh Sheth
- FRIGE's Institute of Human Genetics, Ahmedabad, India
| | - Harsh Sheth
- FRIGE's Institute of Human Genetics, Ahmedabad, India.
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Mastoridis S, Patel V, Christakoudi S, Lozano JJ, Salehi S, Kurt A, Grossart C, Kodela E, Martinez-Llordella M, Sanchez-Fueyo A. Impact of liver failure on the circulating extracellular vesicle miRNA repertoire. Hepatol Res 2023; 53:771-785. [PMID: 37060575 DOI: 10.1111/hepr.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/19/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND & AIMS Cell-derived small extracellular vesicles (sEVs) participate in cell-cell communication via the transfer of molecular cargo including selectively enriched microRNAs (miRNAs). Utilizing advances in sEV isolation and characterization, this study investigates the impact of liver injury and dysfunction on the circulating EV-miRNA profile. METHODS High-throughput screening of 799 sEV-miRNAs isolated from plasma was performed in patients across a spectrum of liver disorders including compensated and decompensated chronic liver disease, acute-on-chronic liver failure (ACLF), and acute liver failure, in addition to healthy controls and those with severe sepsis. miRNA levels were compared with clinical and biochemical parameters, composite scores of liver disease, and patient outcomes. RESULTS miRNA screening revealed the degree of hepatic dysfunction to be the main determinant of changes in circulating sEV-miRNA profile, with liver-specific miRNA-122 being among the most highly dysregulated in severe injury. Principal components analyses of the 215 differentially expressed miRNAs showed differing profiles, particularly among those with acute liver injury and ACLF. A distinct profile of dysregulated miRNA, but not circulating cytokines, was shown to characterize ACLF, with four consensus miRNAs identified-miR-320e, miR-374-5p, miR-202-3p, and miR-1910-5p. High miR-320e was associated with poorer 90-day survival (p = 0.014) and regulated the functional gene targets IK, RPS5, MANBAL, and PEBP1. CONCLUSIONS This first comprehensive analysis to the best of our knowledge of patients with varying degrees and stages of liver failure demonstrates miRNA profiles specifically within the sEV compartment to be significantly altered in progressive liver disease and highlights the diagnostic and prognostic potential of sEV-miRNA in ACLF while also establishing downstream gene targets.
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Affiliation(s)
- Sotiris Mastoridis
- Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Vishal Patel
- Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
- The Roger Williams Institute of Hepatology (Foundation for Liver Research), London, UK
| | - Sofia Christakoudi
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Juan Jose Lozano
- Bioinformatic Platform, Biomedical Research Centre in Hepatic and Digestive Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Siamak Salehi
- Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Ada Kurt
- Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Cathleen Grossart
- Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Elisavet Kodela
- Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Marc Martinez-Llordella
- Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alberto Sanchez-Fueyo
- Institute of Liver Studies, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
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Mwangi W, Kaddu R, Njoki Muiru C, Simiyu N, Patel V, Sulemanji D, Otieno D, Okelo S, Chikophe I, Pisani L, Dona DPG, Beane A, Haniffa R, Misango D, Waweru-Siika W. Organisation, staffing and resources of critical care units in Kenya. PLoS One 2023; 18:e0284245. [PMID: 37498872 PMCID: PMC10374136 DOI: 10.1371/journal.pone.0284245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/27/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors. MATERIALS AND METHODS An online cross-sectional survey was used to collect data on organisational characteristics (model of care, type of unit, quality- related activities, use of electronic medical records and participation in the national ICU registry), staffing and available resources for monitoring, ventilation and general critical care. RESULTS The survey included 60 of 75 identified units (80% response rate), with 43% (n = 23) located in government facilities. A total of 598 critical care beds were reported with a median of 6 beds (interquartile range [IQR] 5-11) per unit, with 26% beds (n = 157) being non functional. The proportion of ICU beds to total hospital beds was 3.8% (IQR 1.9-10.4). Most of the units (80%, n = 48) were mixed/general units with an open model of care (60%, n = 36). Consultants-in-charge were mainly anesthesiologists (69%, n = 37). The nurse-to-bed ratio was predominantly 1:2 with half of the nurses formally trained in critical care. Most units (83%, n = 47) had a dedicated ventilator for each bed, however 63% (n = 39) lacked high flow nasal therapy. While basic multiparametric monitoring was ubiquitous, invasive blood pressure measurement capacity was low (3% of beds, IQR 0-81%), and capnography moderate (31% of beds, IQR 0-77%). Blood gas analysers were widely available (93%, n = 56), with 80% reported as functional. Differences between the public and private sector were narrow. CONCLUSION This study shows an established critical care network in Kenya, in terms of staffing density, availability of basic monitoring and ventilation resources. The public and private sector are equally represented albeit with modest differences. Potential areas for improvement include training, use of invasive blood pressure and functionality of blood gas analysers.
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Affiliation(s)
- Wambui Mwangi
- Department of Anesthesia and Intensive Care, Nyeri County Referral Hospital, Nyeri, Kenya
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
| | - Ronnie Kaddu
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Intensive Care Unit, Aga Khan Mombasa Hospital, Mombasa, Kenya
| | - Carolyne Njoki Muiru
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Egerton University Surgery Department, Nakuru Level V ICU, Nakuru, Kenya
- Department of Anesthesia and Critical Care, AAR Hospital, Nairobi, Kenya
| | - Nabukwangwa Simiyu
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Intensive Care, Kisii County Referral Hospital, Kisii, Kenya
| | - Vishal Patel
- Department of Anesthesia and Intensive Care, MP Shah Hospital, Nairobi, Kenya
| | - Demet Sulemanji
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Critical Care, AAR Hospital, Nairobi, Kenya
| | - Dorothy Otieno
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
| | - Stephen Okelo
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Critical Care, Maseno University, Maseno, Kenya
| | - Idris Chikophe
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia and Critical Care, Kenyatta National Hospital, Nairobi, Kenya
| | - Luigi Pisani
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | | | - Abi Beane
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - Rashan Haniffa
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - David Misango
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia, Aga Khan University, Nairobi, Kenya
| | - Wangari Waweru-Siika
- Kenya Critical Care Registry, Critical Care Society of Kenya, Nairobi, Kenya
- Department of Anesthesia, Aga Khan University, Nairobi, Kenya
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Ostovari M, Zhang Z, Patel V, Jurkovitz C. Telemedicine and health disparities: Association between the area deprivation index and primary care telemedicine utilization during the COVID-19 pandemic. J Clin Transl Sci 2023; 7:e168. [PMID: 37588680 PMCID: PMC10425871 DOI: 10.1017/cts.2023.580] [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: 01/31/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction The rapid implementation of telemedicine during the COVID-19 pandemic may have exacerbated the existing health disparities. This study investigated the association between the area deprivation index (ADI), which serves as a measure of socioeconomic deprivation within a geographic area, and the utilization of telemedicine in primary care. Methods The study data source was electronic health records. The study population consisted of patients with at least one primary care visit between March 2020 and December 2021. The primary outcome of interest was the visit modality (office, phone, and video). The exposure of interest was the ADI score grouped into quartiles (one to four, with one being the least deprived). The confounders included patient sociodemographic characteristics (e.g., age, gender, race, ethnicity, insurance coverage, marital status). We utilized generalized estimating equations to compare the utilization of telemedicine visits with office visits, as well as phone visits with video visits. Results The study population included 41,583 patients with 127,165 office visits, 39,484 phone visits, and 20,268 video visits. Compared to patients in less disadvantaged neighborhoods (ADI quartile = one), patients in more disadvantaged neighborhoods (ADI = two, three, or four) had higher odds of using phone visits vs office visits, lower odds of using video visits vs office visits, and higher odds of using phone visits vs video visits. Conclusions Patients who resided in socioeconomically disadvantaged neighborhoods mainly relied on phone consultations for telemedicine visits with their primary care provider. Patient-level interventions are essential for achieving equitable access to digital healthcare, particularly for low-income individuals.
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Affiliation(s)
- Mina Ostovari
- Christiana Care Health Services Inc., Wilmington, DE, USA
| | - Zugui Zhang
- Christiana Care Health Services Inc., Wilmington, DE, USA
| | - Vishal Patel
- Christiana Care Health Services Inc., Wilmington, DE, USA
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28
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de Pinho IS, Barroso T, Trabulo C, Campoa E, Patel V, Gonçalves L, Araújo J, Monteiro C, Ferreira A, Machado B, Dâmaso S, Luz P, de Sousa RT, Costa L. P159 Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio are not predictive of Pathologic Complete Response to Neoadjuvant Chemotherapy in Triple-negative Breast Cancer. Breast 2023. [DOI: 10.1016/s0960-9776(23)00276-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: 03/16/2023] Open
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29
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Tao S, Zhou X, Lin C, Patel V, Westerhold EM, Middlebrooks EH. Optimization of MP2RAGE T1 mapping with radial view-ordering for deep brain stimulation targeting at 7 T MRI. Magn Reson Imaging 2023; 100:55-63. [PMID: 36924805 DOI: 10.1016/j.mri.2023.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/28/2023] [Accepted: 03/12/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE Deep brain stimulation (DBS) is an effective treatment of various neurological disorders. Due to higher intrinsic signal, 7 T MRI can potentially improve delineation of DBS targets. However, the severe RF transmit field (B1+) inhomogeneity at 7 T can compromise the image contrast of traditional single-contrast sequences for DBS targeting, leading to sub-optimal target visualization. The Magnetization Prepared 2 Rapid Acquisition Gradient Echo (MP2RAGE)-based T1 mapping provides an alternative to the traditional single-contrast techniques by allowing retrospective synthesis of images at arbitrary inversion times to aid in visualization of various DBS targets. With this approach, optimization of sequence parameters to create T1 maps with low noise and low quantification bias is critical, as these characteristics directly affect the noise and uniformity of the synthetic images. In this work, we perform sequence optimization for MP2RAGE-based T1 mapping using a radial view-ordering technique to improve image quality, and demonstrate the clinical utility of T1 mapping approach for DBS targeting. METHODS We first introduce a systematic sequence optimization framework for 7 T MP2RAGE T1 mapping by formulating it into a constrained, multi-dimensional optimization process considering the effect of B1+ inhomogeneity on image noise, T1 quantification bias, and image blurring. With this framework, we investigate the use of radial view-order approach for T1 mapping, in lieu of the conventional linear view-ordering. Bloch's equation-based simulations were performed to compare the T1 maps generated using different approaches. Images of healthy volunteer and patients were acquired on a clinical 7 T MRI scanner for validation and to demonstrate the utility of T1 mapping for DBS targeting. RESULTS Numerical experiments demonstrated that the proposed framework allowed optimization of image SNR in T1 maps while controlling the quantification bias and image blurring, therefore facilitating the selection of optimal sequence parameters for visualizing DBS targets. The optimized sequence using radial view-ordering offered 40-60% noise reduction compared to the linear view-ordering. The improvement of SNR was confirmed in the in vivo examples. Clinical images showed that the synthetic images generated from the optimized T1 maps allowed clear visualization of DBS targets. CONCLUSION We demonstrated the optimization of MP2RAGE T1 mapping with radial view-ordering technique for DBS targeting at 7 T and showed that the optimized sequence allows retrospective generation of synthetic inversion time images commonly utilized in DBS targeting, such as fast gray matter acquisition T1 inversion recovery (FGATIR) and edge-enhancing gradient echo (EDGE) sequences.
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Affiliation(s)
- Shengzhen Tao
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA.
| | - Xiangzhi Zhou
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Vishal Patel
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
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Patel V, Rodrigues D. A282 RISK FACTORS ASSOCIATED WITH UNSUCCESSFUL HIGH-RESOLUTION MANOMETRY: FAILURE IS COMMON BUT WHAT CAN WE CHANGE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991398 DOI: 10.1093/jcag/gwac036.282] [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: 03/09/2023] Open
Abstract
Background High-resolution manometry (HRM) is a diagnostic tool used to evaluate esophageal motor function and diagnose motility disorders. A standardized protocol is used to make an accurate diagnosis based on the Chicago Classification. Some existing literature suggests that incomplete or imperfect manometry tests are common, however; there remains a paucity of data to evaluate risk factors for failure to help clinicians determine when a study may be difficult to perform. Purpose Our goal was to quantify how often failed tests occurred and determine specific factors that may be associated with failed HRM. Method We retrospectively evaluated records for HRM tests performed over 1 year at our academic centre. Based on clinical experience, we identified several factors that may be associated with the success of HRM testing including the following: indications and symptoms leading to testing, patient’s age and biological sex, previous esophageal manometry history, previous esophageal/gastric surgery, previous septal repair/deviated septum, history of significant nausea/vomiting, history of anxiety/depression, history of irritable bowel syndrome, and medication use (opioids, proton pump inhibitors, calcium channel blockers, nitrates). We then compared patients with successful HRM vs. unsuccessful HRM with regard to our pre-specified risk factors. Result(s) 29 HRM tests were unsuccessful from a total of 152 that were performed (19% failure rate). Reasons for failure included the inability to pass the probe through LES (55%) and the inability to tolerate the manometry probe for a minimum of 10 saline swallows (45%). After separating the failed cases from successful tests, both groups had a similar distribution of age and sex. Specific symptoms and indications did not have a significant association with unsuccessful tests. A previous history of failed manometry was associated with unsuccessful HRM (OR: 15, 95% CI 1.88 to 183.8, p=0.0156). Conversely, PPI usage was associated with fewer failed HRM tests (OR: 0.37, 95% CI 0.16 to 0.90, p=0.0343). Other medical history or medication use was not found to be associated with testing failure in our study. Conclusion(s) HRM is useful for diagnosing esophageal motility disorders, but incomplete tests are common. Although this study did not identify any factors in a patient’s medical history that could be used to predict failure in patients who have never had testing, further investigations may identify if PPI therapy can make HRM testing more tolerable. Additionally, the association between previous failed HRM and repeat failures suggests that endoscopic probe placement techniques should be considered instead of retrying conventional probe placement. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- V Patel
- Queen's University, Kingston, Canada
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31
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Tao S, Zhou X, Greco E, Gupta V, Freund BE, Westerhold EM, Feyissa AM, Tatum WO, Grewal S, Patel V, Middlebrooks EH. Edge-Enhancing Gradient-Echo MP2RAGE for Clinical Epilepsy Imaging at 7T. AJNR Am J Neuroradiol 2023; 44:268-270. [PMID: 36732031 PMCID: PMC10187818 DOI: 10.3174/ajnr.a7782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/15/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Abstract
The 3D edge-enhancing gradient-echo (EDGE) MR imaging sequence offers superior contrast-to-noise ratio in the detection of focal cortical dysplasia. EDGE could benefit from 7T MR imaging but also faces challenges such as image inhomogeneity and low acquisition efficiency. We propose an EDGE-MP2RAGE sequence that can provide both EDGE and T1-weighted contrast, simultaneously, improving data-acquisition efficiency. We demonstrate that with sequence optimization, EDGE images with sufficient uniformity and T1-weighted images with high gray-to-white matter contrast can be achieved.
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Affiliation(s)
- S Tao
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | - X Zhou
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | - E Greco
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | - V Gupta
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | | | - E M Westerhold
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | | | | | - S Grewal
- Neurosurgery (S.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - V Patel
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
| | - E H Middlebrooks
- From the Departments of Radiology (S.T., X.Z., E.G., V.G., E.M.W., V.P., E.H.M.)
- Neurosurgery (S.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
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du Pisanie J, Ramakrishnan V, Patel V, Commander C, Yu H. Abstract No. 50 Skeletal Muscle Enhancement on Contrast-Enhanced MRI: A Potential Imaging Biomarker for Severity of Systemic Inflammation and Liver Dysfunction in Cirrhotic Patients. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.093] [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
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Patel V, Tang Y, Lee A, Frangieh A. CUCKOO FOR A CASE OF COCONUT ATRIUM: EXTENSIVE CARDIAC CALCIFICATION DUE TO LEFT ATRIAL MYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04076-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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34
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Li J, Li S, Park KE, Wen J, Lee J, Ayala FA, Lerner A, Gokoffski KK, Zhang-Nunes S, Patel V, Chang JR. Re: "Correlation of Automated Computed Tomography Volumetric Analysis Metrics With Motility Disturbances in Thyroid Eye Disease". Ophthalmic Plast Reconstr Surg 2023; 39:194. [PMID: 36867765 DOI: 10.1097/iop.0000000000002353] [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: 03/05/2023]
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35
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Brahmbhatt P, Kumar T, Bhatt AA, Vibhute P, Patel V, Desai A, Gupta V, Agarwal A. Sinonasal Schwannomas: Imaging Findings and Review of Literature. Ear Nose Throat J 2023:1455613221150573. [PMID: 36775665 DOI: 10.1177/01455613221150573] [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] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE Schwannomas are common nerve sheath tumors and may occur anywhere in the body. 4% of head and neck schwannomas occur in the sinonasal cavity, and fewer yet have an intracranial component, making these presentations extremely rare. Furthermore, schwannomas present with nonspecific imaging signs and can only be definitively differentiated via histopathologic review, leading to misdiagnosis as various nasal tumors. We aim to conduct a review of published literature on sinonasal schwannomas with and without intracranial extension and provide additional case representations. METHODS A literature review was conducted using the PubMed Database with the terms "sinonasal schwannoma," "intracranial," "anterior skull base," and "schwannoma." Results were reviewed, and additional cases identified were referenced and included in the study. Inclusion criteria were any case with intracranial extension of the schwannoma. There were no exclusion criteria. Review data was compiled into Excel and used for data analysis and comparison. Additionally, a search was done within our institution to identify additional cases of sinonasal schwannoma. RESULTS We identified 17 cases of sinonasal schwannoma with intracranial extension, five from our institution and twelve from literature. Analysis revealed: 8 females (47%), 9 males (53%), 9 patients presented with headaches (53%), 6 patients presented with anosmia (35%), 4 patients presented with nasal obstruction (24%), and 2 patients with no symptoms (12%). Mean age and median were 39.4 ± 10.1 and 40, respectively. For treatment, 4 patients underwent endoscopic resection (24%), 11 underwent craniotomy (65%), and data was unavailable for 2 patients. Post-treatment complications occurred in 6 patients, 5 had CSF leaks (29%) and 1 had a hematoma (6%). CONCLUSION We identified and discussed 17 cases of sinonasal schwannoma with intracranial extension. We hope our review provides insight for clinicians to maintain schwannoma as a potential differential when evaluating nasal and anterior skull base masses.
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Affiliation(s)
| | - Tushar Kumar
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Alok A Bhatt
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Vishal Patel
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Amit Desai
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Vivek Gupta
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Amit Agarwal
- Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
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36
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Govorov A, Kolontarev K, Diyakov V, Arutyunyan P, Moschovas M, Jaber A, Patel V, Pushkar D. Treatment of Zinner syndrome with robot-assisted surgery. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Mohan S, Koo Lin L, Ho TC, Zhang-Nunes S, Patel V, Chang JR. Lateral orbital wall anomaly in a patient with thyroid eye disease. Orbit 2023; 42:94-97. [PMID: 34404314 DOI: 10.1080/01676830.2021.1966812] [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] [Indexed: 01/28/2023]
Abstract
An isolated defect in the lateral orbital wall is an uncommon occurrence, although cases of orbital floor, roof, and medial wall spontaneous dehiscence have been described in the literature. Here, we describe a lateral orbital wall defect in a patient with thyroid eye disease - which may be related to bony remodeling or may represent a rare congenital anomaly. Computed tomography (CT) prior to decompression surgery revealed a defect in the left lateral orbital wall. At the time of orbital decompression, prolapse of buccal fat into the orbit was noted once the subperiosteal plane was entered along the lateral orbital wall in the area of this bony defect. Literature review revealed only a few previous reports of lateral wall abnormalities, including two involving the inferior orbital fissure; one other case was associated with Down syndrome, and other reports consist of sphenoid hypoplasia associated with neurofibromatosis.
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Affiliation(s)
- Sukriti Mohan
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Lily Koo Lin
- Department of Ophthalmology and Vision Science, University of California Davis Health Eye Center, Sacramento, California, USA
| | - Tiffany C Ho
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sandy Zhang-Nunes
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Vishal Patel
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jessica R Chang
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Bravi C, Dall’Oglio P, Mazzone E, De Groote R, Falagario U, Schiavina R, Piazza P, Borghesi M, Scarcella S, Moschovas M, Turri F, Andras I, Di Maida F, Carrieri G, Terrone C, Autorino R, Patel V, Porpiglia F, Bocciardi A, Minervini A, Montorsi F, Rha K, Mottrie A. The surgical learning curve for positive surgical margins after robot-assisted radical prostatectomy: Results from a multi-institutional collaboration. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01145-4] [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: 02/12/2023]
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39
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Lakhia R, Mishra A, Biggers L, Malladi V, Cobo-Stark P, Hajarnis S, Patel V. Enhancer and super-enhancer landscape in polycystic kidney disease. Kidney Int 2023; 103:87-99. [PMID: 36283570 PMCID: PMC9841439 DOI: 10.1016/j.kint.2022.08.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 11/19/2021] [Revised: 06/15/2022] [Accepted: 08/19/2022] [Indexed: 11/07/2022]
Abstract
Widespread aberrant gene expression is a pathological hallmark of polycystic kidney disease (PKD). Numerous pathogenic signaling cascades, including c-Myc, Fos, and Jun, are transactivated. However, the underlying epigenetic regulators are poorly defined. Here we show that H3K27ac, an acetylated modification of DNA packing protein histone H3 that marks active enhancers, is elevated in mouse and human samples of autosomal dominant PKD. Using comparative H3K27ac ChIP-Seq analysis, we mapped over 16000 active intronic and intergenic enhancer elements in Pkd1-mutant mouse kidneys. We found that the cystic kidney epigenetic landscape resembles that of a developing kidney, and over 90% of upregulated genes in Pkd1-mutant kidneys are co-housed with activated enhancers in the same topologically associated domains. Furthermore, we identified an evolutionarily conserved enhancer cluster downstream of the c-Myc gene and super-enhancers flanking both Jun and Fos loci in mouse and human models of autosomal dominant PKD. Deleting these regulatory elements reduced c-Myc, Jun, or Fos abundance and suppressed proliferation and 3D cyst growth of Pkd1-mutant cells. Finally, inhibiting glycolysis and glutaminolysis or activating Ppara in Pkd1-mutant cells lowerd global H3K27ac levels and its abundance on c-Myc enhancers. Thus, our work suggests that epigenetic rewiring mediates the transcriptomic dysregulation in PKD, and the regulatory elements can be targeted to slow cyst growth.
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Affiliation(s)
- Ronak Lakhia
- Department of Internal Medicine, Nephrology, UT Southwestern Medical Center, Dallas, Texas, USA.
| | - Abheepsa Mishra
- Department of Internal Medicine, Nephrology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Laurence Biggers
- Department of Internal Medicine, Nephrology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Venkat Malladi
- Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Patricia Cobo-Stark
- Department of Internal Medicine, Nephrology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sachin Hajarnis
- Department of Internal Medicine, Nephrology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Vishal Patel
- Department of Internal Medicine, Nephrology, UT Southwestern Medical Center, Dallas, Texas, USA
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Williams B, Doran Shelley P, Patel V, Prothro C, Reynolds SS. Using PDSA cycles to improve oral care compliance. Am J Infect Control 2023; 51:110-113. [PMID: 35577059 DOI: 10.1016/j.ajic.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023]
Abstract
Oral care has been shown to reduce healthcare-associated pneumonia (HAP) rates, however, compliance with this practice is suboptimal. Using quality improvement PDSA cycles over an 8-week period, we saw improvements in oral care documentation compliance through statistical process control charts; HAP rates did not significantly decrease. Infection prevention leadership should consider regularly incorporating PDSA cycles to improve compliance with evidence-based infection prevention practices.
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Affiliation(s)
| | | | | | | | - Staci S Reynolds
- Adult Health Division, Duke University School of Nursing, Durham, NC; Duke University Hospital, Infection Prevention and Hospital Epidemiology, Durham, NC.
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Patel V, Balasubramaniam D, Cavero-Chavez V, Cuervo-Pardo L, Sanchez-Alvarez C. Clinical Presentation of Schnitzler's Syndrome: A Rare Autoimmune Disease. J Investig Med High Impact Case Rep 2023; 11:23247096231220480. [PMID: 38130124 DOI: 10.1177/23247096231220480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Schnitzler's Syndrome (SS) is a rare late-onset acquired autoinflammatory disorder which consists of chronic urticaria associated with a monoclonal IgM-kappa gammopathy, arthralgias, skeletal hyperostosis, lymphadenopathy, and recurrent constitutional symptoms. The average age of diagnosis is 51 years with a slight male predominance with a male to female ratio of 1.6. Diagnosis of SS requires the presence of 2 major criteria including chronic urticaria and monoclonal IgM along with at least two of the following minor criteria: recurrent intermittent fevers, bone pain, arthralgias, elevated erythrocyte sedimentation rate (ESR), neutrophilic dermal infiltrate on skin biopsy, and leukocytosis or elevated C-reactive protein (CRP). Early diagnosis and clinical awareness are paramount in SS as it is associated with a 15-20% risk of lymphoproliferative malignancy. The median overall survival is 12.8 years. We present a case of a 39-year-old female with new onset urticaria associated with recurrent fevers and joint pain. Symptoms were refractory to steroids, and high dose antihistamines. Multi-disciplinary evaluation resulted in the ultimate diagnosis of Schnitzler's Syndrome. The patient was ultimately treated with canakinumab (Il-1 inhibitor), with near resolution of symptoms. This case demonstrates the importance of a broad differential diagnosis and maintaining a high clinical suspicion for rare diseases when presented with a complex form of an otherwise common condition.
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Maxwell KN, Patel V, Nead KT, Merrill S, Clark D, Jiang Q, Wubbenhorst B, D’Andrea K, Cohen RB, Domchek SM, Morrissette JJ, Greenberg RA, Babushok DV, Nathanson KL. Fanconi anemia caused by biallelic inactivation of BRCA2 can present with an atypical cancer phenotype in adulthood. Clin Genet 2023; 103:119-124. [PMID: 36089892 PMCID: PMC9742260 DOI: 10.1111/cge.14231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 12/14/2022]
Abstract
Inherited biallelic pathogenic variants (PVs) in BRCA2 cause Fanconi Anemia complementation group D1 (FA-D1), a severe pediatric bone marrow failure and high-risk cancer syndrome. We identified biallelic BRCA2 PVs in a young adult with multiple basal cell carcinomas, adult-onset colorectal cancer and small cell neuroendocrine carcinoma, without bone marrow failure. No PVs were identified in any other known cancer susceptibility gene, and there was no evidence of reversion mosaicism. The proband's deceased sister had a classic FA-D1 presentation and was shown to carry the same biallelic BRCA2 PVs. A lymphoblastoid cell line derived from the proband demonstrated hypersensitivity to DNA damaging agents, and bone marrow showed aberrant RAD51 staining. Family expansion demonstrated the presence of BRCA2 related cancers in heterozygous family members. Our data highlight the striking phenotypic differences which can be observed within FA-D1 families and expands the clinical spectrum of FA-D1 to include adult presentation with a constellation of solid tumors not previously thought of as characteristic of Fanconi Anemia. Early recognition of this syndrome in a family could prevent further morbidity and mortality by implementation of hereditary breast and ovarian cancer screening and treatment strategies for heterozygous family members.
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Affiliation(s)
- Kara N. Maxwell
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Vishal Patel
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kevin T. Nead
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Shana Merrill
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Dana Clark
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Qinqin Jiang
- Department of Cancer Biology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Bradley Wubbenhorst
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kurt D’Andrea
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Roger B. Cohen
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Susan M. Domchek
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jennifer J.D. Morrissette
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Roger A. Greenberg
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Cancer Biology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Daria V. Babushok
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Katherine L. Nathanson
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Cheng MM, Gibbons DC, Birch H, Patel V, Bell CF, Drysdale M, Satram S, Reyes CM. 1145. Real-world Effectiveness of Sotrovimab for the Early Treatment of COVID-19 in the US. Open Forum Infect Dis 2022. [PMCID: PMC9752579 DOI: 10.1093/ofid/ofac492.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Sotrovimab, a monoclonal antibody (mAb), received Emergency Use Authorization (EUA) for the treatment of high-risk outpatients with symptomatic COVID-19. The study objective was to evaluate real-world effectiveness of sotrovimab (500 mg intravenous) in reducing the risk of mortality or hospitalization during the SARS-CoV-2 Delta and initial Omicron variant waves in the US. Methods A retrospective analysis was conducted of de-identified patients (pts) diagnosed with COVID-19 (ICD-10: U07.1) from 9/1/2021 to 2/28/2022 in the FAIR Health FH NPIC® claims database. Pts were divided into 2 cohorts based on HCPCS codes: treated with sotrovimab and not treated with any mAb (no mAb). Pts meeting EUA high-risk criteria were identified via pre-specified ICD-10-CM diagnoses in records ≤ 24 months prior to their first COVID-19 diagnosis (index date). Facility-reported mortality (referred to as “mortality”), all cause hospitalizations and intensive care unit (ICU) admissions within 30 days of index were identified. Chi-square test, ANOVA, or t-tests were performed to statistically compare cohorts at a 0.05 level of significance (2-sided). P-values were not adjusted for multiplicity. Multivariable logistic regression was conducted to estimate the risk of mortality or hospitalization within 30 days, adjusting for demographic and clinical factors. Results Of the high-risk COVID-19 pts identified, 13,140 were treated with sotrovimab and 1,283,284 received no mAb therapy. Compared to the no mAb cohort, the sotrovimab cohort was older, had more baseline conditions, and were more likely to be female (all p < 0.0001). In the no mAb cohort, 0.59% died and 5.74% were hospitalized (of whom 30% in ICU). In the sotrovimab cohort, 0.08% died and 2.50% were hospitalized (of whom 15% in ICU). After adjusting for potential confounders, treatment with sotrovimab was associated with 83% reduced odds of 30-day mortality (OR: 0.17, 95% CI: 0.09-0.31) and 61% reduced odds of 30-day hospitalization or mortality (OR: 0.39, 95% CI: 0.35-0.43) among high-risk COVID-19 pts. Conclusion In this US real-world observational study of high-risk COVID-19 pts during the Delta and initial Omicron waves, treatment with sotrovimab was associated with reduced odds of mortality and hospitalization compared to no mAb treatment. Disclosures Mindy M. Cheng, PhD, Vir Biotechnology: Employee, Shareholder Daniel C. Gibbons, PhD, GlaxoSmithKline: Employee, GlaxoSmithKline GSK shareholder Helen Birch, PhD, GlaxoSmithKline: Employee, GlaxoSmithKline GSK shareholder Vishal Patel, MSc, GlaxoSmithKline: Employee, GlaxoSmithKline Christopher F. Bell, n/a, GlaxoSmithKline: Employee, GlaxoSmithKline GSK shareholder Myriam Drysdale, PhD, GlaxoSmithKline: Employee, GlaxoSmithKline GSK shareholder Sacha Satram, PhD, Vir Biotechnology: Employee, Vir Biotechnology Vir shareholder Carolina M. Reyes, PhD, Vir Biotechnology: Employee, Vir Biotechnology Vir shareholder.
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Affiliation(s)
| | | | - Helen Birch
- GSK, Brentford, Middlesex, England, United Kingdom
| | - Vishal Patel
- GSK, Brentford, Middlesex, England, United Kingdom
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Goncalves L, Gonçalves D, Esteban Casanelles T, Soares de Pinho I, Barroso T, Patel V, Esperanca-Martins M, Brás R, Lobo-Martins S, Semedo P, Moreira C, Teixeira Sousa A, Mansinho A, Marques Da Costa L. 100P Immunotherapy around the clock: Impact on stage IV melanoma. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100204] [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: 12/13/2022]
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Sadh K, Murthy MS, Dutta D, Patel V, Basavarajappa C, Mahale R, Muliyala KP. Autoimmune Encephalitis Following Severe Traumatic Brain Injury. Prim Care Companion CNS Disord 2022; 24. [DOI: 10.4088/pcc.21cr03198] [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: 11/09/2022] Open
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Patel V, Petersen JM, Jhala D. Highly Effective, Easy, & Simple Model for the Day-to-Day Monitoring of Blood Bank Inventory Leading to Successful Operations to Provide Blood Products in the Times of Blood Product Shortage Nationally Due to COVID-19 Pandemic. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.337] [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: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Providing blood products in a timely manner is very important and is an integral part of the health care system to provide best patient care. Transfusion medicine services should be well prepared to respond to blood product demands in a timely manner. Due to the COVID-19 pandemic, all the transfusion medicine services nationally have been facing blood product shortages. A model was created in Pathology & Laboratory services (P&LMS) at the Corporal Michael J. Crescenz Veteran Affairs Medical Center (CMC VAMC) to communicate effectively to the patient care team to keep up with ongoing clinical care demands despite the national blood shortage.
Methods/Case Report
Transfusion medicine team at CMC VAMC communicated to patient care team about the national shortage of blood products. All blood requests were evaluated for appropriate usage of blood. Also, PACS (Peri Operative cells Savers) services was considered for Operating room for patient with major blood loss. Daily blood inventory was evaluated, closely monitored, and communicated to patient care team to meet the demands from Jan 16th, 2022, to April 11th, 2022. Importantly, P&LMS created a simple model where each blood product in reduction was recorded every morning and evening. This simple method of 24/7 real time monitoring of the supply of blood products helped tremendously in decision making for procedure prioritization based on clinical indications and contributed to the continued successful clinical operation.
Results (if a Case Study enter NA)
Procedures were successfully prioritized according to the blood supply. Simultaneously, there was no delay in issuing blood products as clinically needed. A significant amount of reduced inventory noted from Jan 16th, 2022, to April 11th, 2022; the average reduction was O+ 53% reduced and A+ 44% reduced.
Conclusion
By monitoring the day-to-day blood bank inventory effectively, P&LMS at CMC VAMC was able to support all the critical clinical needs by providing blood products in a timely manner. P&LMS services was able to reduce the wastage and was able to provide all the critical blood product without any significant delays by monitoring in Realtime. The value of collaborating and communicating to the patient care team cannot be understated as it is both simple and highly cost effective.
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Affiliation(s)
- V Patel
- Pathology and Laboratory Services, Corporal Michael J. Crescenz VA Medical Center Philadelphia , Philadelphia, Pennsylvania , United States
| | - J M Petersen
- Pathology and Laboratory Medicine, Corporal Michael J. Crescenz Veteran Affairs Medical Center and University of Pennsylvania , Philadelphia, Pennsylvania , United States
| | - D Jhala
- Pathology and Laboratory Medicine, Corporal Michael J. Crescenz Veteran Affairs Medical Center and University of Pennsylvania , Philadelphia, Pennsylvania , United States
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Patel S, Patel V, Petersen JM, Jhala D. A Holistic Approach for an Efficient Day to Day Operation for Blood Bank Market Withdrawals and Recalls Using Departmental Electronic Occurrence System: A CMCVAMC Experience. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.336] [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: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Donor centers and reagent manufacturers may issue recalls or market withdrawals. Donor center withdrawals of blood components involve units that have a reason that may present a risk to the patient, that subsequently require discarding the product if not transfused or appropriate clinical notification and follow-up if already transfused prior to the notification. Reagent recalls involve problems with reagents that require appropriate corrective action as per the circumstances. Patient safety event reporting systems are universal in hospitals and are a backbone of efforts to detect patient safety events and quality problems. Pathology and Laboratory Medicine (P&LMS) at the Corporal Michael J. Crescenz Veteran Affairs Medical Center (CMC VAMC) has established an electronic occurrence reporting (EOR) program to track and respond to these in the blood bank. The authors explored the usefulness of the holistic approach of this initiative.
Methods/Case Report
EOR is available to all the employees of Blood Bank in P&LMS, who regularly report all received recalls and market withdrawals into the system. These are reviewed by the supervisor and blood bank medical director and co-director to ensure appropriate steps are taken. Information on all market recalls and withdrawals affecting blood bank were compiled from January 1st, 2021, to June 1st, 2022, for quality assurance review.
Results (if a Case Study enter NA)
The EOR plays a significant role in organizing the data from all the recalls and market withdrawals to guide improvement in patient care. There were seven market withdrawals during the study period, all from the donor center for blood product component withdrawals. All seven cases were recorded efficiently with review by the blood bank supervisor and blood bank medical director and co-director. Appropriate follow-up action was performed and recorded for all seven cases in the EOR.
Conclusion
The EOR for withdrawals recalls in Blood Bank is highly effective, successful program in terms of electronic organized monitoring. This monitoring is part of ensuring quality care in real time, and plays an important role as part of Veteran Affairs position as a High reliability Organization (HRO).
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Affiliation(s)
- S Patel
- Pathology and Laboratory Medicine , CMC VAMC , Philadelphia , Pennsylvania , United States
| | - V Patel
- Pathology and Laboratory Medicine , CMC VAMC , Philadelphia , Pennsylvania , United States
| | - J M Petersen
- Pathology and Laboratory Medicine , CMC VAMC , Philadelphia , Pennsylvania , United States
| | - D Jhala
- Pathology and Laboratory Medicine , CMC VAMC , Philadelphia , Pennsylvania , United States
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Petersen JM, Jhala D, Patel V. Continuing Profound Impact of Continued Education Sessions on Blood Bank Specimen Labeling Years Later at the Veteran Affairs Medical Center. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.334] [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: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
Proper patient identification is a critical safety element for transfusion medicine, particularly for the prevention of acute hemolytic transfusion reactions (AHTR). Mislabeled specimens have been documented to carry an increased risk of patient misidentification. Therefore, the submission of a mislabeled specimen to the blood bank generally results in a specimen rejection with a redraw. At the Philadelphia Veteran Affairs Medical Center, an identification bracelet with alphanumeric code is used to help improve transfusion safety but also has additional patient labeling requirements. The redrawing of blood bank specimens poses risks in phlebotomy, and a quality improvement initiative was previously undertaken to educate staff on proper blood specimen and band labeling and usage to prevent labeling errors, improve safety in patient care, and reduce intended redraws.
Methods/Case Report
Colorful laminated posters delineating the labeling requirements and process for blood bank specimens collected using the blood bank system were made and distributed at the time of in-service training by the blood bank in 2017 to the areas of the hospital whereby errors had been noted to occur in the past. The dedicated in-service training was repeated prior to the change in the identification blood band from the Hollister Ident-ATM Blood Recipient Band (Precision Diagnostics Corporation, Valencia CA) to the Typenex Blood Bands (Typenex Medical, Chicago IL) on 11/12/2019. As part of the quality metrics of the blood bank, blood bank specimen labeling errors was tracked from 2017 to track the persistence of the effect of the initial training.
Results (if a Case Study enter NA)
The percentage of properly labeled specimens as a percentage of total specimens increased after the in-service training; specifically, an increase from a low of 97% (December 2017) to a high of 99% (August 2018). The percentage of properly labeled specimens remains at the increased level of 99% and above even at the 4.5-year mark in mid-2022.
Conclusion
The continued availability of laminated educational posters on blood specimen labeling for the clinical service areas combined with initial in-service education can have lasting effects to improve the quality of care even years after the initial in-service education sessions.
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Affiliation(s)
- J M Petersen
- Pathology and Laboratory Medicine, CMCVAMC and University of Pennsylvania , Philadelphia, Pennsylvania , United States
| | - D Jhala
- Pathology and Laboratory Medicine, CMCVAMC and University of Pennsylvania , Philadelphia, Pennsylvania , United States
| | - V Patel
- Department of Pathology and Laboratory Medicine, Corporal Michael J. Crescenz VA Medical Center , Philadelphia, Pennsylvania , United States
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Algarin Y, McCullum C, Patel V. Skin Cancer Screening Practices Among Dermatologists: A Survey Study. J Drugs Dermatol 2022; 21:1235-1241. [DOI: 10.36849/jdd.6660] [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: 11/09/2022]
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Soares De Pinho I, Simão D, Roldán Galanares M, Lopes-Brás R, Patel V, Esperança-Martins M, Gonçalves L, Alves L, Fernandes I, Gamez Casado S, Artacho Criado S, Baena Cañada J, Costa J, Fernandes A, Teixeira de Sousa R, Costa L, Luz P. Anthracycline versus no anthracycline neoadjuvant therapy for HER2 breast cancer: real world evidence. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01516-7] [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: 11/19/2022]
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