1
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Javed U, Bhatia K. Total intravenous anaesthesia for caesarean delivery: incidence, maternal and neonatal outcomes from a tertiary unit. Int J Obstet Anesth 2024; 57:103933. [PMID: 37866971 DOI: 10.1016/j.ijoa.2023.103933] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/01/2023] [Accepted: 09/23/2023] [Indexed: 10/24/2023]
Affiliation(s)
- U Javed
- Department of Anaesthesia, Health Education England North-West, Manchester, UK
| | - K Bhatia
- Department of Anaesthesia, Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.
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2
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Knapp C, Bhatia K, Columb M, Elriedy M. Remifentanil patient-controlled analgesia for labour in pregnant patients with heart disease. Int J Obstet Anesth 2023; 55:103902. [PMID: 37302184 DOI: 10.1016/j.ijoa.2023.103902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Affiliation(s)
- C Knapp
- Department of Anaesthesia, Health Education England North-West, Manchester, UK
| | - K Bhatia
- Department of Anaesthesia, Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - M Columb
- Intensive Care Unit, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - M Elriedy
- Department of Anaesthesia, University Hospitals of Derby and Burton, Derby and Burton on Trent, UK
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3
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Bhatia K, D'Souza R, Malhamé I, Thorne S. Anaesthetic considerations in pregnant patients with cardiac arrhythmia. BJA Educ 2023; 23:196-206. [PMID: 37124169 PMCID: PMC10140473 DOI: 10.1016/j.bjae.2023.01.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/27/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- K. Bhatia
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R. D'Souza
- McMaster University, Hamilton, Ontario, Canada
| | - I. Malhamé
- McGill University Health Centre, Montreal, Quebec, Canada
| | - S. Thorne
- University of Toronto Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada
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4
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Chen Y, Häring V, Selzam V, Schwingenschuh P, Bhatia K, Volkmann J, Peach R, Schreglmann S. P-73 Feature-based learning differentiates Essential and Functional Tremor. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.090] [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: 03/08/2023]
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5
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Eusuf D, Bhatia K, Kochhar P, Columb M. A national survey on the availability of prefilled medication syringes and medication errors in maternity units across the United Kingdom. Int J Obstet Anesth 2023; 53:103617. [PMID: 36549952 DOI: 10.1016/j.ijoa.2022.103617] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Affiliation(s)
- D Eusuf
- Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - K Bhatia
- Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.
| | - P Kochhar
- Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - M Columb
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
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6
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Knapp C, Bhatia K. Maternal collapse in pregnancy. Br J Hosp Med (Lond) 2022; 83:1-12. [PMID: 36594762 DOI: 10.12968/hmed.2022.0259] [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: 12/13/2022]
Abstract
Maternal collapse is a rare life-threatening event that can occur at any stage of pregnancy or up to 6 weeks postpartum. Prompt identification and timely intervention by a multidisciplinary team that includes an obstetrician, midwifery staff and an obstetric anaesthetist are essential to improve maternal and fetal outcomes. Standard adult resuscitation guidelines need to be followed with some modifications, taking into account the maternal-fetal physiology, which clinicians should be familiar with. During cardiac arrest, the emphasis is on advanced airway management, manual uterine displacement to relieve aortocaval compression and performing a resuscitative hysterotomy (peri-mortem caesarean delivery) swiftly in patients who are more than 20 weeks gestation to improve maternal survival. Annual multidisciplinary simulation training is recommended for all professionals involved in maternity care; this can improve teamwork, communication and emergency preparedness during maternal collapse.
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Affiliation(s)
- C Knapp
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - K Bhatia
- Department of Anaesthesia, St Mary's Hospital, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
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7
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Bhatia K, Aggarwal D, Ochoa-Jimenez R, Lopez P, Konje S, Argulian E. Prognostic utility of left ventricular global longitudinal strain in patients with systemic amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial deposition of amyloid proteins results in restrictive cardiomyopathy. Left ventricular global longitudinal strain (GLS) has emerged as a sensitive measure for detecting subclinical cardiac dysfunction over traditional echocardiographic parameters. However, multiple studies have provided differing conclusions regarding prognostic utility of impaired GLS in patients with systemic amyloidosis.
Purpose
We conducted a systematic review and meta-analysis to evaluate whether impaired GLS was associated with increased mortality or major adverse cardiovascular events (MACE) in patients with systemic amyloidosis.
Methods
We performed a literature search of Embase, Medline and Web of Science databases to identify studies that reported the association of GLS with clinical outcomes in patients with systemic amyloidosis (light chain or TTR amyloidosis). Outcomes of interest included all-cause mortality and MACE, defined as a composite of death or heart transplant or heart failure hospitalization. Unadjusted and adjusted hazard ratio (uHR and aHR respectively) were pooled using a random effects model. Heterogeneity among the studies was assessed using the Higgins I2 value.
Results
Out of 2139 initial citations, 28 observational studies with a total of 2713 patients were included in the analysis. The mean age ranged between 58–78 years and 62% of the patients were male. Most patients had cardiac amyloidosis (83%) and light-chain amyloidosis accounted for 69% of cases. Mean follow-up ranged between 1 and 5 years. GLS was significantly higher (less negative) (mean difference (MD) −3.69 [−5.94, −1.44], I2=87, p<0.01) in non-survivors compared with survivors. Similarly, patients who experienced MACE had a significantly higher mean GLS (MD −3.22, [−5.21, −1.22,], I2=82, p<0.01]. The risk of both mortality and MACE increased significantly for every −1% increase in GLS. In unadjusted models, a GLS above the defined threshold value was associated with a significantly higher risk of mortality (uHR: 1.66 [1.22, 5.21], I2=85.2, p<0.01) and MACE (uHR: 2.24 [1.28, 3.92], I2=39, p<0.01). In multivariable models an increase in GLS by −1% was an independent predictor of mortality (aHR: 1.09 [1.01,1.16], I2=53, p=0.02) and MACE (aHR: 1.24 [1.14,1.36], I2=0, p<0.01).
Conclusion
In patient with amyloidosis, the baseline left ventricular GLS may help identify patients with a higher risk of mortality and MACE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Bhatia
- Mount Sinai Heart, Mount Sinai Morningside , New York , United States of America
| | - D Aggarwal
- Beaumont Health System, Internal Medicine , Troy , United States of America
| | - R Ochoa-Jimenez
- Mount Sinai Heart, Mount Sinai Morningside , New York , United States of America
| | - P Lopez
- Mount Sinai Heart, Mount Sinai Morningside , New York , United States of America
| | - S Konje
- Mount Sinai Heart, Mount Sinai Morningside , New York , United States of America
| | - E Argulian
- Mount Sinai Heart, Mount Sinai Morningside , New York , United States of America
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8
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Dhaliwal A, Kaur A, Konje S, Bhatia K, Sohal S, Rawal H, Turagam M, Gwon Y, Mamas M, Dominguez A, Bhatt D, Velagapudi P. Comparing direct oral anticoagulants versus vitamin K antagonist in patients with atrial fibrillation after transcatheter aortic valve replacement: an updated meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Oral anticoagulation therapy is indicated for patients undergoing transcatheter aortic valve replacement (TAVR) with concomitant or new onset atrial fibrillation (AF). However the data on optimal anticoagulation regimen in this population remains unclear.
Purpose
To compare efficacy and safety outcomes of direct oral anticoagulants (DOACs) versus Vitamin K antagonists (VKA) in patients with AF post TAVR.
Methods
We searched electronic databases (PubMed, Embase, Scopus, Cochrane) from inception to February28th, 2022 using MeSH terms and keywords for DOACs, AF or TAVR. Primary outcome of interest was all-cause stroke or systemic embolic event. Secondary safety outcomes were major bleeding and all-cause mortality. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random-effects model. Interstudy heterogeneity was assessed using the Higgins I 2 value. All statistical analysis were performed using RevMan 5.4.1 software.
Results
We identified five eligible studies (1RCT, 4 observational) including 3694 patients (DOAC n=1581, VKA n=2113). The mean age was 81.4±0.9 years. The mean follow-up was 12.4±14.3 months. Type of DOACs included apixaban (n=394, 24.9%), rivaroxaban (n=354, 22.4%), dabigatran (n=119, 7.5%) and edoxaban (n=714, 45.2%).There was no significant difference in primary outcome of stroke or systemic embolic event (RR: 0.93; CI: 0.65–1.33; p>0.05; I2=5%), or in secondary outcomes of major bleeding (RR: 1.02; CI: 0.78–1.34; p>0.05; I2=44%) and all-cause mortality (RR: 0.87; CI: 0.59–1.27; p>0.05; I2=56%) between DOACs and VKA groups.
Conclusion
This meta-analysis shows anticoagulation therapy with DOACs has similar safety and efficacy outcomes compared to VKA in patients with AF undergoing TAVR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Dhaliwal
- New York Hand Surgery , New York , United States of America
| | - A Kaur
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - S Konje
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - K Bhatia
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - S Sohal
- Newark Beth Israel Medical Center , Newark , United States of America
| | - H Rawal
- Insight Hospital and Medical Center , Chicago , United States of America
| | - M Turagam
- Mount Sinai Hospital , New York , United States of America
| | - Y Gwon
- University of Nebraska Medical Center , Omaha , United States of America
| | - M Mamas
- Keele University , Keele , United Kingdom
| | - A Dominguez
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - D Bhatt
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | - P Velagapudi
- University of Nebraska Medical Center , Omaha , United States of America
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9
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Aggarwal D, Bhatia K, Lopez P, Bohra C, Joshi A, Daibes J, Mahmood K, Fox A. Left ventricular unloading with Impella versus IABP in patients on VA-ECMO for cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use for circulatory support in shock is limited by increased left ventricular afterload. Impella and intra-aortic balloon pump (IABP) can be used in conjunction with VA-ECMO to help unload the left ventricle. Data comparing the two strategies are limited.
Purpose
We performed a systematic review and meta-analysis of published data to compare outcomes of patients with shock supported by VA-ECMO in conjunction with Impella versus IABP.
Methods
We conducted a search of Medline, Embase, and Cochrane databases to identify studies comparing the use of Impella versus IABP in patients on VA-ECMO. The primary outcome of interest was all-cause mortality (in-hospital or 30-day). Secondary outcomes included transition to destination therapy with left ventricular assist device (LVAD) or transplant, stroke, need for continuous renal replacement therapy (CRRT), bleeding, and hemolysis. Risk ratios (RR) with 95% confidence interval and the heterogeneity statistic I2 were reported for each outcome.
Results
Six observational studies with a total of 629 patients were included in the analysis. Of these, 205 (33%) and 424 (67%) patients were supported by Impella and IABP respectively, in addition to VA-ECMO. All six studies reported the primary outcome. No difference was observed in all-cause mortality between VA-ECMO with Impella and VA-ECMO with IABP (RR 1.02 [0.74–1.40], I2=74%). Similar rates were observed for transition to LVAD or transplant (RR 0.75 [0.45–1.27], I2=0%), stroke (RR 1.50 [0.80–2.83], I2=0%), and need for CRRT (RR 1.04 [0.82–1.32], I2=0%). However, use of VA-ECMO with Impella was associated with a higher risk of bleeding (RR 1.91 [1.28–2.86], I2=68%) and hemolysis (RR 4.61 [1.24–17.17], I2=66%) as compared with use of VA-ECMO with IABP.
Conclusion
In patients with shock requiring VA-ECMO, concurrent use of Impella and IABP had similar risk of mortality, transition to LVAD/transplant, stroke, and need for CRRT. However, Impella use was associated with higher risk of bleeding and hemolysis. Randomized trials are needed to identify the optimal strategy for left ventricular unloading in patients with cardiogenic shock on VA-ECMO.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Aggarwal
- Beaumont Health System, Internal Medicine , Troy , United States of America
| | - K Bhatia
- Mount Sinai Heart, Mount Sinai Morningside , New York , United States of America
| | - P Lopez
- Mount Sinai Heart, Mount Sinai Morningside , New York , United States of America
| | - C Bohra
- Mount Sinai Heart, Mount Sinai Morningside , New York , United States of America
| | - A Joshi
- Mount Sinai Heart, Mount Sinai Morningside , New York , United States of America
| | - J Daibes
- Mount Sinai Heart, Mount Sinai Morningside , New York , United States of America
| | - K Mahmood
- The Zena and Michael A. Wiener Cardiovascular Institute, Cardiovascular Institute , New York , United States of America
| | - A Fox
- The Zena and Michael A. Wiener Cardiovascular Institute, Cardiovascular Institute , New York , United States of America
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10
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Kaur A, Dhaliwal A, Sohal S, Bhatia K, Sharma V, Cohen M, Visveswaran G, Salonia J, Kodra A, Basman C, Kliger C. Efficacy and safety outcomes of ultrasound assisted thrombolysis versus standard catheter direct thrombolysis in patients with submassive or massive pulmonary embolism: an updated meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The use of catheter-based thrombolysis in comparison to systemic thrombolytics has emerged as a potentially lifesaving therapy for patients with sub massive or massive pulmonary embolism (PE). The addition of ultrasound waves to accelerate lytic dispersion in ultrasound assisted thrombolysis (USAT) has been proposed to improve outcomes as compared to standard catheter-directed thrombolysis (SCDT). These two modalities have been compared in small studies, but larger population data on the outcomes of these therapies is still lacking.
Purpose
To assess the efficacy and safety of USAT versus SCDT in patients with submassive or massive pulmonary embolism.
Methods
A review of electronic databases (PubMed, Scopus, Embase, and Cochrane) was performed using keywords USAT, SCDT and PE and studies were included if efficacy and safety outcomes were compared between the two types of therapies. Efficacy outcomes that were evaluated included the reduction in right ventricle/left ventricle ratio (RV/LV ratio), pulmonary artery systolic pressure (PASP) and Miller score. Safety outcomes that were evaluated included major bleeding, mortality and length of ICU stay. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for continuous variables. Risk ratio (RR) and 95% CI were reported for dichotomous variables using the random effects model in comprehensive meta-analysis and RevMan 5.4.1 softwares.
Results
Six studies with a total of 381 patients (USAT n=204; SCDT n=177) were included. No statistical difference in efficacy outcomes of USAT over SCDT was noted in the degree of RV/LV ratio reduction (SMD: −0.507; CI: −1.386–0.373; p>0.05; I2=92%), PASP reduction (SMD: 0.037; CI: −0.404–0.478; p>0.05; I2=59%), or Miller score reduction (SMD: 0.303; CI: −0.481– 1.087; p>0.05; I2=82%). Safety outcomes were also not statistically different with similar rates of major bleeding (RR: 1.44; CI: 0.54–3.85; p>0.05; I2=4%), mortality (RR: 1.46; CI: 0.35–6.05; p>0.05; I2=0%) and length of ICU stay (SMD: −0.01; CI: −0.29–0.27; p>0.05; I2=31%) in both treatment groups.
Conclusion
Our data suggest that despite the technological advancement of USAT, there is no additional benefit over SCDT in terms of efficacy and safety. Further studies are warranted for both procedures investigating financial and clinical outcomes in real world practice.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kaur
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - A Dhaliwal
- New York Hand Surgery , New York , United States of America
| | - S Sohal
- Newark Beth Israel Medical Center , Newark , United States of America
| | - K Bhatia
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - V Sharma
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - M Cohen
- Newark Beth Israel Medical Center , Newark , United States of America
| | - G Visveswaran
- Newark Beth Israel Medical Center , Newark , United States of America
| | - J Salonia
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - A Kodra
- Lenox Hill Heart and Vascular Institute , New York , United States of America
| | - C Basman
- Lenox Hill Heart and Vascular Institute , New York , United States of America
| | - C Kliger
- Lenox Hill Heart and Vascular Institute , New York , United States of America
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11
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Kaur A, Dhaliwal A, Khandait H, Konje S, Bhatia K, Sohal S, Turagam M, Gwon Y, Mamas M, Dominguez A, Bhatt D, Velagapudi P. To compare efficacy and safety of direct oral anticoagulants in patients with concurrent atrial fibrillation and bioprosthetic heart valve repair or replacement: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Use of direct oral anticoagulants (DOACs) is contraindicated in patients with mechanical valves. However data on their use in patients with atrial fibrillation (AF) and bioprosthetic valves (BV) is still limited.
Purpose
To assess the safety and efficacy of DOACs versus Vitamin K antagonist (VKA) in patients with AF after BV repair or replacement.
Methods
We performed a comprehensive review of electronic databases (PubMed, Embase, Scopus, Cochrane) using MeSH terms and keywords for DOACs, AF and BVs from inception through December 2021. Randomized clinical trials (RCT) or observational studies that reported clinical outcomes comparing DOACs versus VKA in patients with AF and BVs were eligible for inclusion. Ten articles were reviewed for full text. Primary outcome was a composite of all cause stroke or systemic embolic event.
Secondary outcomes included major bleeding and all-cause mortality. Subgroup analysis stratified by study design was performed. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using Mantel-Haenszel method with DerSimonian-Laird estimator for tau2 for random effects model.
Interstudy heterogeneity was assessed using the Higgins I 2 value. All statistical analysis was performed using RevMan 5.4.1 software.
Results
Ten studies (5 RCTs, 5 observational studies) with a total of 5,333 patients (DOACs n=2434; VKA n=2899) were included. Aortic, mitral and mixed BV repair or replacement were 74.2%, 25.6% and 0.02% respectively. The mean age was 72.6±11.9 years. The mean follow-up was 15.7±12.9 months. Type of DOACs included apixaban (n=553, 22.7%), rivaroxaban (n=893, 36.7%), dabigatran (n=151, 6.2%) and edoxaban (n=837, 34.4%). There was no significant difference in primary outcome of stroke or systemic embolic event (RR: 0.79; CI: 0.56–1.11; p>0.05; I2=12%) or secondary outcomes of major bleeding (RR: 0.84; CI: 0.64–1.11; p>0.05; I2=45%), and all-cause mortality (RR: 0.84; CI: 0.64–1.11; p>0.05; I2=29%) between DOACs compared with VKA.
Conclusion
In patients with AF and BV, DOACs are non-inferior to VKA for risk of stroke or systemic embolism, major bleeding, and all-cause mortality. Thus, DOACs can serve as a viable alternative to VKAs which have a narrow therapeutic index, multiple drug interactions, and require frequent monitoring.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kaur
- Icahn School of Medicine at Mount Sinai Morningside West , New York City , United States of America
| | - A Dhaliwal
- New York Hand Surgery , New York , United States of America
| | - H Khandait
- Trinitas Regional Medical Center, Elizabeth , New Jersey , United States of America
| | - S Konje
- Icahn School of Medicine at Mount Sinai Morningside West , New York City , United States of America
| | - K Bhatia
- Icahn School of Medicine at Mount Sinai Morningside West , New York City , United States of America
| | - S Sohal
- Newark Beth Israel Medical Center , Newark , United States of America
| | - M Turagam
- Mount Sinai Hospital , New York , United States of America
| | - Y Gwon
- University of Nebraska Medical Center , Omaha , United States of America
| | - M Mamas
- Keele University , Keele , United Kingdom
| | - A Dominguez
- Icahn School of Medicine at Mount Sinai Morningside West , New York City , United States of America
| | - D Bhatt
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | - P Velagapudi
- University of Nebraska Medical Center , Omaha , United States of America
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12
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Markey T, Bhatia K. Accidental oral administration of Monsel’s solution during caesarean delivery. Int J Obstet Anesth 2022; 52:103597. [DOI: 10.1016/j.ijoa.2022.103597] [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] [Received: 06/21/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
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13
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Bhatia K, Columb M, Shelton C, Lie J, Leach S, Froud O, Verma D, Sturgess P, Sawyerr A, Desai J, Gould N, Kumari S, Sen U, Verma P, Kamath P, Koirala A, Kimber‐Craig S, Eccles J, Bewlay A, Eslam E, Radwan M, Hulgur M, Christian J, Aiyad A. Epidural labour analgesia rates during the
COVID
‐19 pandemic in the north‐west of England. Anaesthesia 2022; 77:1055-1056. [DOI: 10.1111/anae.15780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
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14
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Bhatia K, Moshkun C. Sedation and HIV medication. Br Dent J 2022; 232:841-842. [PMID: 35750810 DOI: 10.1038/s41415-022-4411-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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15
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Fletcher J, Jones B, Bhatia K. P.147 Maternal, anaesthetic and neonatal outcomes for parturients with ischaemic heart disease. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103443] [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: 10/18/2022]
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16
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Markey T, Bhatia K, Patel S. P.72 Accidental oral administration of Monsel's solution during caesarean delivery. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103368] [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: 10/18/2022]
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Knapp C, Bhatia K, Columb M. P.27 Haemodynamic stability of remifentanil patient-controlled analgesia during labour in parturients with cardiac disease. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103323] [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: 11/26/2022]
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18
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Bhatia K, Shehata N, D'Souza R. Anaesthetic considerations and anticoagulation in pregnant patients with mechanical heart valves. BJA Educ 2022; 22:273-281. [DOI: 10.1016/j.bjae.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bhatia K. Obstetric analgesia and anaesthesia in SARS-CoV-2-positive parturients across 10 maternity units in the north-west of England: a retrospective cohort study. Anaesthesia 2022; 77:389-397. [PMID: 35226768 PMCID: PMC9111485 DOI: 10.1111/anae.15672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/11/2022]
Abstract
Since the start of the COVID‐19 pandemic, few studies have reported anaesthetic outcomes in parturients with SARS‐CoV‐2 infection. We reviewed the labour analgesic and anaesthetic interventions utilised in symptomatic and asymptomatic parturients who had a confirmed positive test for SARS‐CoV‐2 across 10 hospitals in the north‐west of England between 1 April 2020 and 31 May 2021. Primary outcomes analysed included the analgesic/anaesthetic technique utilised for labour and caesarean birth. Secondary outcomes included a comparison of maternal characteristics, caesarean birth rate, maternal critical care admission rate along with adverse composite neonatal outcomes. A positive SARS‐CoV‐2 test was recorded in 836 parturients with 263 (31.4%) reported to have symptoms of COVID‐19. Neuraxial labour analgesia was utilised in 104 (20.4%) of the 509 parturients who went on to have a vaginal birth. No differences in epidural analgesia rates were observed between symptomatic and asymptomatic parturients (OR 1.03, 95%CI 0.64–1.67; p = 0.90). The neuraxial anaesthesia rate in 310 parturients who underwent caesarean delivery was 94.2% (95%CI 90.6–96.0%). The rates of general anaesthesia were similar in symptomatic and asymptomatic parturients (6% vs. 5.7%; p = 0.52). Symptomatic parturients were more likely to be multiparous (OR 1.64, 95%CI 1.19–2.22; p = 0.002); of Asian ethnicity (OR 1.54, 1.04–2.28; p = 0.03); to deliver prematurely (OR 2.16, 95%CI 1.47–3.19; p = 0.001); have a higher caesarean birth rate (44.5% vs. 33.7%; OR 1.57, 95%CI 1.16–2.12; p = 0.008); and a higher critical care utilisation rate both pre‐ (8% vs. 0%, p = 0.001) and post‐delivery (11% vs. 3.5%; OR 3.43, 95%CI 1.83–6.52; p = 0.001). Eight neonates tested positive for SARS‐CoV‐2 while no differences in adverse composite neonatal outcomes were observed between those born to symptomatic and asymptomatic mothers (25.8% vs. 23.8%; OR 1.11, 95%CI 0.78–1.57; p = 0.55). In women with COVID‐19, non‐neuraxial analgesic regimens were commonly utilised for labour while neuraxial anaesthesia was employed for the majority of caesarean births. Symptomatic women with COVID‐19 are at increased risk of significant maternal morbidity including preterm birth, caesarean birth and peripartum critical care admission.
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Affiliation(s)
- K Bhatia
- Manchester University NHS Foundation Trust, Manchester, UK
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20
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Aruede G, Carey E, Bhatia K, Smart K. 1678 A Rare Example of a Simple Bone Cyst of The Ascending Ramus in A Paediatric Patient. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A simple bone cyst is described as an intra-osseous pseudocyst, devoid of an epithelial lining and either empty of filled with serous or sanguineous fluid. This case presents a rare example of a simple bone cyst of the ascending ramus of the mandible in a paediatric patient. Studies have shown that less than 5% of simple bone cysts of the jaw bones are located within the mandibular ramus, with the most common site being the premolar-molar region (75%). The 14-year-old female was referred by her orthodontist to the local Oral and Maxillofacial department, for an incidental finding on her pre-orthodontic OPT of a radiolucency in the left ascending ramus. Her medical history was clear, she was asymptomatic and had no sensory deficit. A CT scan demonstrated a 22mm multilocular radiolucency centred on the left ascending ramus, extending superiorly up to the base of the coronoid process and condylar neck. Inferiorly, the radiolucency abutted but did not involve the unerupted third molar. The scan highlighted thinning of the buccal and lingual cortices putting the patient at risk of pathological fracture. The inferior alveolar nerve canal passed through the lingual aspect of the radiolucency. The patient underwent exploration of the left mandible which revealed an empty bony cavity, with no cystic lining or contents. The definitive diagnosis of a simple bone cyst was established. She experienced satisfactory healing by her review appointment 4 weeks post-surgery. Combined radiographic and clinical assessment is important in the diagnosis of simple bone cysts.
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Affiliation(s)
- G Aruede
- Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - E Carey
- Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - K Bhatia
- Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - K Smart
- Prince Charles Hospital, Merthyr Tydfil, United Kingdom
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21
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Chambers DJ, Bhatia K, Columb M. Postpartum cerebral venous sinus thrombosis following obstetric neuraxial blockade: a literature review with analysis of 58 case reports. Int J Obstet Anesth 2021; 49:103218. [PMID: 34598860 DOI: 10.1016/j.ijoa.2021.103218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/17/2021] [Accepted: 09/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is a rare complication of pregnancy. It usually presents with a headache and may mimic a post-dural puncture headache (PDPH) in women who receive a neuraxial block. METHODS Medline, CINAHL and EMBASE databases were searched to identify postpartum cases of CVST following neuraxial block. The aim was to delineate the characteristics, presentation, investigations, and outcomes of postpartum women who presented with CVST. RESULTS Forty-nine articles with 58 case reports were identified. Forty-two women (72.4%) had an epidural attempted whilst 16 women (27.6%) received a spinal anaesthetic. Accidental dural puncture (ADP) was reported in 17 women (40.5%). Headache was the presenting symptom in 57 women (98.3%); 26 women (44.8%) also experienced seizures. Post-dural puncture headache was reported in 46 (79.3%) and an epidural blood patch was performed in 26 women (44.8%). Superior sagittal sinus, transverse sinus, and cortical veins were the most common sites of thrombosis. The median time to diagnosis was 6.5 days from delivery. Magnetic resonance imaging was the most common diagnostic neuro-imaging modality. Full neurological recovery was reported in 48 (82.8%), whilst neurological deficits were reported in six (10.3%) women. DISCUSSION The diagnosis of CVST may be overlooked in women who present with headache following neuraxial block. A change in character of headache with loss of postural element, and focal neurological signs are the key clinical features that could help anaesthetists differentiate headache of CVST from PDPH. The high reported rates of ADP and PDPH lend support to their possible association with CVST.
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Affiliation(s)
| | - K Bhatia
- Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.
| | - M Columb
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
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Chufal K, Ahmad I, Miller A, Bajpai R, Chowdhary R, Umesh P, Bhatia K, Gairola M. PO-1790 Alpha-Beta ratio estimation and radiotherapeutic equivalence of chemotherapy in oesophageal cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Schreglmann S, Wang D, Peach R, Li J, Zhang X, Latorre A, Rhodes E, Panella E, Boyden E, Barahona M, Santaniello S, Rothwell J, Bhatia K, Grossman N. FV 12. Non-invasive Suppression of Essential Tremor via Phase-Locked Disruption of its Temporal Coherence. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alshehri H, Dmytriw AA, Bhatia K, Bickford S, Rea V, Shkumat N, Muthusami P. Transradial Neuroendovascular Procedures in Adolescents: Initial Single-Center Experience. AJNR Am J Neuroradiol 2021; 42:1492-1496. [PMID: 33958331 DOI: 10.3174/ajnr.a7142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The feasibility and safety of transradial angiography is not established outside the adult literature. The objective of this study was to assess the feasibility and safety of transradial access for neuroangiography in adolescents. MATERIALS AND METHODS A retrospective case-control study was performed, comparing transradial neuroendovascular procedures in adolescents (age range, 10-18 years) with an age- and procedure-matched cohort of transfemoral neuroendovascular procedures. Clinical and procedural details, including type of procedure, conversion rate, fluoroscopy time, radiation dose, complications, and readmissions, were reported by descriptive statistics or measures of central tendency and compared using a t test or nonparametric equivalent. A P value < .05 was considered statistically significant. RESULTS Twenty adolescents (mean age, 14.6 [SD, 1.7] years, M/F ratio = 9:11) who underwent transradial neuroangiography were compared against 20 adolescents (mean age, 14.4 [SD, 2.1 ] years, M/F ratio = 12:8) who underwent transfemoral neuroangiography. We found no significant difference in procedural success (0% conversion rate), fluoroscopy times (33.7 [SD, 40.2] minutes versus 23.3 [SD, 26.2] minutes, P = .34) and radiation dose (150.9 [SD, 133.7] Gy×cm2 and 122.9 [SD, 79.7] Gy×cm,2 P = .43) There were 2 self-limiting postprocedural complications in the transradial group. There were no major hemorrhages, need for further interventions, or readmissions in either group. CONCLUSIONS The benefits of transradial angiography described for adults can likely be safely extended to adolescents. These are important data before transitioning to smaller children and should be prospectively evaluated in a larger cohort.
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Affiliation(s)
- H Alshehri
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - A A Dmytriw
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - K Bhatia
- Department of Medical Imaging (K.B.), Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - S Bickford
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - V Rea
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - N Shkumat
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - P Muthusami
- From the Divisions of Neuroradiology and Image-Guided Therapy (H.A., A.A.D., S.B., V.R., N.S., P.M.), Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Okeke Ogwulu CB, Williams EV, Chu JJ, Devall AJ, Beeson LE, Hardy P, Cheed V, Yongzhong S, Jones LL, La Fontaine Papadopoulos JH, Bender-Atik R, Brewin J, Hinshaw K, Choudhary M, Ahmed A, Naftalin J, Nunes N, Oliver A, Izzat F, Bhatia K, Hassan I, Jeve Y, Hamilton J, Debs S, Bottomley C, Ross J, Watkins L, Underwood M, Cheong Y, Kumar CS, Gupta P, Small R, Pringle S, Hodge FS, Shahid A, Horne AW, Quenby S, Gallos ID, Coomarasamy A, Roberts TE. Cost-effectiveness of mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage: an economic evaluation based on the MifeMiso trial. BJOG 2021; 128:1534-1545. [PMID: 33969614 DOI: 10.1111/1471-0528.16737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of mifepristone and misoprostol (MifeMiso) compared with misoprostol only for the medical management of a missed miscarriage. DESIGN Within-trial economic evaluation and model-based analysis to set the findings in the context of the wider economic evidence for a range of comparators. Incremental costs and outcomes were calculated using nonparametric bootstrapping and reported using cost-effectiveness acceptability curves. Analyses were performed from the perspective of the UK's National Health Service (NHS). SETTING Twenty-eight UK NHS early pregnancy units. SAMPLE A cohort of 711 women aged 16-39 years with ultrasound evidence of a missed miscarriage. METHODS Treatment with mifepristone and misoprostol or with matched placebo and misoprostol tablets. MAIN OUTCOME MEASURES Cost per additional successfully managed miscarriage and quality-adjusted life years (QALYs). RESULTS For the within-trial analysis, MifeMiso intervention resulted in an absolute effect difference of 6.6% (95% CI 0.7-12.5%) per successfully managed miscarriage and a QALYs difference of 0.04% (95% CI -0.01 to 0.1%). The average cost per successfully managed miscarriage was lower in the MifeMiso arm than in the placebo and misoprostol arm, with a cost saving of £182 (95% CI £26-£338). Hence, the MifeMiso intervention dominated the use of misoprostol alone. The model-based analysis showed that the MifeMiso intervention is preferable, compared with expectant management, and this is the current medical management strategy. However, the model-based evidence suggests that the intervention is a less effective but less costly strategy than surgical management. CONCLUSIONS The within-trial analysis found that based on cost-effectiveness grounds, the MifeMiso intervention is likely to be recommended by decision makers for the medical management of women presenting with a missed miscarriage. TWEETABLE ABSTRACT The combination of mifepristone and misoprostol is more effective and less costly than misoprostol alone for the management of missed miscarriages.
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Affiliation(s)
- C B Okeke Ogwulu
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - E V Williams
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J J Chu
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A J Devall
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - L E Beeson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - P Hardy
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - V Cheed
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S Yongzhong
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - L L Jones
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J H La Fontaine Papadopoulos
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | - K Hinshaw
- Sunderland Royal Hospital, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, UK
| | - M Choudhary
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A Ahmed
- Sunderland Royal Hospital, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, UK
| | - J Naftalin
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - N Nunes
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Isleworth, UK
| | - A Oliver
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - F Izzat
- University Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - K Bhatia
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - I Hassan
- Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Y Jeve
- Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - J Hamilton
- Guy's and St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - S Debs
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Bottomley
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Ross
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - L Watkins
- Liverpool Women's Hospital, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - M Underwood
- Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Y Cheong
- Department of Reproductive Medicine, University of Southampton, Southampton, UK
| | - C S Kumar
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - P Gupta
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Small
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Pringle
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - F S Hodge
- Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - A Shahid
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - A W Horne
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - S Quenby
- The Biomedical Research Unit in Reproductive Health, University of Warwick, Warwick, UK
| | - I D Gallos
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Coomarasamy
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - T E Roberts
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Roberts S, Naqvi A, Bhatia K, Simcox L, Vause S. P.45 Maternal, anaesthetic and neonatal outcomes in pregnant women with mechanical prosthetic valves. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103043] [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: 10/21/2022]
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Bhatia K, Columb M, Bewlay A, Tageldin N, Knapp C, Qamar Y, Dooley A, Kamath P, Hulgur M. Decision-to-delivery interval and neonatal outcomes for category-1 caesarean sections during the COVID-19 pandemic. Anaesthesia 2021; 76:1051-1059. [PMID: 33891311 PMCID: PMC8251307 DOI: 10.1111/anae.15489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/29/2023]
Abstract
General anaesthesia is known to achieve the shortest decision‐to‐delivery interval for category‐1 caesarean section. We investigated whether the COVID‐19 pandemic affected the decision‐to delivery interval and influenced neonatal outcomes in patients who underwent category‐1 caesarean section. Records of 562 patients who underwent emergency caesarean section between 1 April 2019 and 1 July 2019 in seven UK hospitals (pre‐COVID‐19 group) were compared with 577 emergency caesarean sections performed during the same period during the COVID‐19 pandemic (1 April 2020–1 July 2020) (post‐COVID‐19 group). Primary outcome measures were: decision‐to‐delivery interval; number of caesarean sections achieving decision‐to‐delivery interval < 30 min; and a composite of adverse neonatal outcomes (Apgar 5‐min score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit admission and stillbirth). The use of general anaesthesia decreased significantly between the pre‐ and post‐COVID‐19 groups (risk ratio 0.48 (95%CI 0.37–0.62); p < 0.0001). Compared with the pre‐COVID‐19 group, the post‐COVID‐19 group had an increase in median (IQR [range]) decision‐to‐delivery interval (26 (18–32 [4–124]) min vs. 27 (20–33 [3–102]) min; p = 0.043) and a decrease in the number of caesarean sections meeting the decision‐to‐delivery interval target of < 30 min (374/562 (66.5%) vs. 349/577 (60.5%); p = 0.02). The incidence of adverse neonatal outcomes was similar in the pre‐ and post‐COVID‐19 groups (140/568 (24.6%) vs. 140/583 (24.0%), respectively; p = 0.85). The small increase in decision‐to‐delivery interval observed during the COVID‐19 pandemic did not adversely affect neonatal outcomes.
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Affiliation(s)
- K Bhatia
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Manchester Medical School, University of Manchester, Manchester, UK
| | - M Columb
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Department of Intensive Care Medicine, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - A Bewlay
- Department of Anaesthesia, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - N Tageldin
- Department of Anaesthesia and Peri-operative Medicine, Saint Mary's Hospital, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - C Knapp
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - Y Qamar
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - A Dooley
- Department of Anaesthesia, Liverpool Women's Hospital, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - P Kamath
- Department of Anaesthesia, Royal Bolton Hospital, Bolton NHS Foundation Trust, Bolton, UK
| | - M Hulgur
- Department of Anaesthesia, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Hospital Foundation Trust, Wigan, UK
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Ciofani J, Bhatia K, Bhindi R, Allahwala U. Gastric Volvulus Mimicking ST-Segment Elevation Myocardial Infarction. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bhatia K, Sritharan H, Gautam B, Mughal N, Ekmejian A, Allahwala U, Bhindi R, Hansen P. Non-Nominal Deployment of the SAPIEN 3 Transcatheter Heart Valve: An Ex Vivo Bench Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Bhatia K, Columb MO. COVID-19 pandemic reduces general anaesthesia rates for caesarean section. Anaesthesia 2020; 76 Suppl 3:25-26. [PMID: 33368187 DOI: 10.1111/anae.15368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- K Bhatia
- Manchester University NHS Foundation Trust, Manchester, UK
| | - M O Columb
- Manchester University NHS Foundation Trust, Manchester, UK
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31
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Akhter N, Ahmad S, Alzahrani FA, Dar SA, Wahid M, Haque S, Bhatia K, Sr Almalki S, Alharbi RA, Sindi AAA. Impact of COVID-19 on the cerebrovascular system and the prevention of RBC lysis. Eur Rev Med Pharmacol Sci 2020; 24:10267-10278. [PMID: 33090438 DOI: 10.26355/eurrev_202010_23251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) uses Angiotensin- converting enzyme 2 (ACE2) receptors to infect host cells which may lead to coronavirus disease (COVID-19). Given the presence of ACE2 receptors in the brain and the critical role of the renin-angiotensin system (RAS) in brain functions, special attention to brain microcirculation and neuronal inflammation is warranted during COVID-19 treatment. Neurological complications reported among COVID-19 patients range from mild dizziness, headache, hypogeusia, hyposmia to severe like encephalopathy, stroke, Guillain-Barre Syndrome (GBS), CNS demyelination, infarcts, microhemorrhages and nerve root enhancement. The pathophysiology of these complications is likely via direct viral infection of the CNS and PNS tissue or through indirect effects including post- viral autoimmune response, neurological consequences of sepsis, hyperpyrexia, hypoxia and hypercoagulability among critically ill COVID-19 patients. Further, decreased deformability of red blood cells (RBC) may be contributing to inflammatory conditions and hypoxia in COVID-19 patients. Haptoglobin, hemopexin, heme oxygenase-1 and acetaminophen may be used to maintain the integrity of the RBC membrane.
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Affiliation(s)
- N Akhter
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Albaha University, Albaha, Saudi Arabia. ;
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Bhatia K, Columb M, Bewlay A, Eccles J, Hulgur M, Jayan N, Lie J, Verma D, Parikh R. The effect of COVID-19 on general anaesthesia rates for caesarean section. A cross-sectional analysis of six hospitals in the north-west of England. Anaesthesia 2020; 76:312-319. [PMID: 33073371 DOI: 10.1111/anae.15313] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 12/16/2022]
Abstract
At the onset of the global pandemic of COVID-19 (SARS-CoV-2), guidelines recommended using regional anaesthesia for caesarean section in preference to general anaesthesia. National figures from the UK suggest that 8.75% of over 170,000 caesarean sections are performed under general anaesthetic. We explored whether general anaesthesia rates for caesarean section changed during the peak of the pandemic across six maternity units in the north-west of England. We analysed anaesthetic information for 2480 caesarean sections across six maternity units from 1 April to 1 July 2020 (during the pandemic) and compared this information with data from 2555 caesarean sections performed at the same hospitals over a similar period in 2019. Primary outcome was change in general anaesthesia rate for caesarean section. Secondary outcomes included overall caesarean section rates, obstetric indications for caesarean section and regional to general anaesthesia conversion rates. A significant reduction (7.7 to 3.7%, p < 0.0001) in general anaesthetic rates, risk ratio (95%CI) 0.50 (0.39-0.93), was noted across hospitals during the pandemic. Regional to general anaesthesia conversion rates reduced (1.7 to 0.8%, p = 0.012), risk ratio (95%CI) 0.50 (0.29-0.86). Obstetric indications for caesarean sections did not change (p = 0.17) while the overall caesarean section rate increased (28.3 to 29.7%), risk ratio (95%CI) 1.02 (1.00-1.04), p = 0.052. Our analysis shows that general anaesthesia rates for caesarean section declined during the peak of the pandemic. Anaesthetic decision-making, recommendations from anaesthetic guidelines and presence of an on-site anaesthetic consultant in the delivery suite seem to be the key factors that influenced this decline.
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Affiliation(s)
- K Bhatia
- Department of Anaesthesia and Peri-operative Medicine, University of Manchester, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Columb
- Department of Anaesthesia, Peri-operative and Intensive Care Medicine, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Bewlay
- Department of Anaesthesia, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - J Eccles
- Department of Anaesthesia, Royal Oldham Hospital, Oldham Care Organisation, Northern Care Alliance NHS Group, Oldham, UK
| | - M Hulgur
- Department of Anaesthesia, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Hospital NHS Foundation Trust, Wigan, UK
| | - N Jayan
- Department of Anaesthesia, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Hospital NHS Foundation Trust, Wigan, UK
| | - J Lie
- Department of Anaesthesia, Burnley General Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - D Verma
- Department of Anaesthesia, Liverpool Women's Hospital, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - R Parikh
- Department of Anaesthesia, Liverpool Women's Hospital, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
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Narasimhan B, Ho K, Wu L, Amreia M, Isath A, Bhatia K, Shah A, Kantharia B. Impact of age on the obesity paradox in acute coronary syndrome: a nationwide analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The obesity paradox – indicating improved short term mortality in obese individuals has been widely explored in a number of cardiovascular conditions. However, its validity in an elderly population and the possible physiological impact of aging on this phenomenon in Acute Coronary syndrome (ACS) remain unclear. In this study, we aim to determine the relationship between obesity and in-hospital mortality, morbidity, and health care resource utilization in this cohort of patients.
Methods
A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Elderly adults (≥65 years) with a principal diagnosis of ACS and a secondary diagnosis of obesity were identified using ICD-9 diagnosis codes as described in the literature. The primary outcome of in-hospital mortality and secondary outcomes like length of hospital stay (LOS), and total hospitalization costs were analyzed. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using a multivariate logistic regression model.
Results
In total, 1,137,108 hospital admissions with a primary diagnosis of ACS were identified, of which 7.46% were obese. In-hospital morality during the index admission was lower among obese patients with ACS compared to non-obese patients (4.62 vs 6.87%, p<0.001) with significantly lower 30-day readmission rates as well (p<0.001). However, in-hospital mortality rates during readmission were statistically equivalent between the obese and non-obese groups (5.6 vs 8.3%, p=0.72). LOS during the index admission was longer for obese patients (6.39 vs 5.36 days, p=0.65) but equivalent to non-obese patients during subsequent readmissions (p=0.12). The total cost of these admissions was significantly more in the obese cohort as well (p<0.001).
Conclusion
In this study, obese elderly patients admitted with ACS were found to have significantly reduced in-hospital mortality and 30-day readmission rates when compared to non-obese patients - reinforcing the obesity paradox independent of patient age.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Narasimhan
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - K Ho
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - L Wu
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | | | - A Isath
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - K Bhatia
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Shah
- Cardiovascular and Heart Rhythm consultants, New york, United States of America
| | - B Kantharia
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Bhatia K, Handa S, Das S, Modi V, Joshi A. Acute coronary events in patients with myeloproliferative neoplasms- a nationwide analysis of patient characteristics and in-hospital outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myeloproliferative neoplasms (MPN) are characterized by clonal expansion of cells belonging to the erythroid and/or myeloid lineages. Concomitant platelet dysfunction and thrombocytosis predispose these patients to arterial thromboses, causing a high burden of morbidity and mortality. With improving survival, an increasing number of patients with MPN are presenting with acute coronary syndromes (ACS). However, data regarding in-hospital outcomes and revascularization strategies utilized in these patients is limited, due to lack of representation in trials and rarity of the disease.
Methods
We conducted a retrospective cohort study using the 2016 Nationwide Inpatient Sample.Adult patients with a primary diagnosis of ACS and a secondary diagnosis of MPN, including essential thrombocytosis, polycythemia vera, primary myelofibrosis or chronic myeloproliferative disorder, were identified using the International Classification of Diseases (ICD) 10th revision codes. Outcomes of interest were compared using a multivariate logistic regression model.
Results
Out of 677,304 patients admitted for ACS, 2,485 also had a secondary diagnosis of MPN. Patients with MPN were less frequently female and diabetic but were more likely to have heart failure. No statistical difference in race, smoking or obesity was noted between the two cohorts. There was no significant difference in the in-hospital mortality in ACS patients with or without MPN. In terms of revascularization, patients with MPN were less likely to undergo percutaneous coronary intervention (PCI) and more likely to undergo coronary arterial bypass grafting (CABG). In addition, patients with MPN had a higher odds of acute pulmonary embolism, cardiogenic shock, and acute kidney injury as well as increased length of stay (LOS) and hospitalization costs
Conclusion
In patients with ACS and concomitant MPN, CABG was the preferred mode of revascularization over PCI, which may account for the increased LOS and total cost. Although the in-hospital mortality was similar, patients with MPN had higher odds of In-hospital complications.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Bhatia
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
| | - S Handa
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
| | - S Das
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
| | - V Modi
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
| | - A Joshi
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
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Narasimhan B, Wu L, Lucas C, Bhatia K, Shah A, Kantharia B. Predictors of sudden cardiac arrest in adolescents with mitral valve prolapse: an analysis of the nationwide inpatient sample. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mitral valve prolapse (MVP) is the most commonly encountered valvular pathology seen in 2–3% of the general population. Though traditionally regarded as a benign pathology, recent literature suggests that sudden cardiac death is significantly more common in these patients with estimates of 0.2–0.4%/year. The exact underlying mechanism of these higher rates of SCD remain poorly understood. In this study, we aim to identify predictors of sudden cardiac arrest (SCA) in an adolescent population.
Methods
We conducted a retrospective study using the AHRQ-HCUP National Inpatient Sample 2016-2017 for the years 2016-17. All patients (≤18 years) admitted with Mitral valve prolapse were identified using ICD-10 codes and further sub stratified based on presence or absence of sudden cardiac arrest (SCA). Baseline characteristics were obtained and multivariate regression analysis was utilized to identify potential predictors of SCA. Independent risk factors for in-hospital mortality were identified using a proportional hazards model. Complications were defined as per the Agency for Health Care Research and Quality guideline.
Results
We screened a total of 71,473,874 admissions in the NIS database to identify a total of 1,372 adolescent patients admitted with MVP in the years 2016–17. These patients were then sub-categorized based on presence or absence of SCA during the hospitalization. Our findings revealed that patients with SCA were generally slightly older (15y vs 13y, p=0.036, OR-1.1, p=0.007) and more likely female (83.3% vs 13%, p=0.227, OR – 3.55, p=0.57)). Interestingly, patients in the SCA cohort were noted to have almost 4 fold higher rates of Mitral regurgitation (66.6% vs 18.35%, p=0.008, OR-8.89, p=0.005) as well as family history of SCD (16.7% vs 4.1%, p=0.145, OR-4.65, p=0.14).
Conclusions
Presence of Mitral regurgitation and a family history of sudden cardiac death are associated with significantly higher rates of SCA in adolescent patients with mitral valve prolapse.
Predictors of SCA in Adolescent MVP
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Narasimhan
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - L Wu
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C.H Lucas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - K Bhatia
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Shah
- Cardiovascular and Heart Rhythm consultants, New york, United States of America
| | - B Kantharia
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Wu L, Narasimhan B, Shah A, Zheng Y, Bhatia K, Kantharia B. 10-year trend analysis of atrioventricular node ablation in patient with atrial fibrillation: 2005–2014 United State hospitalization. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Atrial fibrillation (AF) ablation and Atrioventricular Node (AVN) ablation are both important non-pharmacological therapy of AF. In spite of increased availability of AF ablation data, that of AVN ablation per se is limited.
Method
AF ablation was identified using ICD-9 procedure code with principle diagnosis of AF from United States National Inpatient Sample database 2005–2014. From procedure and diagnosis codes of pacemaker insertion followed by ablation, the cohort who underwent AVN ablation was identified. Patients hospitalization with any diagnosis of other type of arrythmia or epicardial ablation were excluded. Complications were defined as per the Agency for Health Care Research and Quality guideline.
Results
Total AF ablation was noted to increase from 2005- 2011, and declined steadily from 2011–2014. In contrast, the number of AVN ablations increased from 4505 cases to 5175 (Figure 1). AVN ablation were mainly performed in elderly patient (mean age 72), and increasingly in patient with higher Charlson Commobidity index (0.9 to 1.7)and higher CHA2DS2-VASc score (2.8 to 3.7) (Table 1). An increasing trend in procedure complications but no significant change in mortalitywere observed with AVN ablation. Progressive increase in the length of stay and the hospitalization cost were also observed over the years with AVN ablation.
Conclusion
AVN ablation is being performed at a steady volume, and increasingly in patients with multiple comorbidities. This trend although was not associated with increased mortality, it was associated with increased hospital complications.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Wu
- Mount Sinai St Luke's and Mount Sinai West Hospital, New York, United States of America
| | - B Narasimhan
- Mount Sinai St Luke's and Mount Sinai West Hospital, New York, United States of America
| | - A.N Shah
- Mount Sinai St Luke's and Mount Sinai West Hospital, New York, United States of America
| | - Y.Y Zheng
- Vidant Medical Center, Pediatrics, Greenvile, United States of America
| | - K Bhatia
- Mount Sinai St Luke's and Mount Sinai West Hospital, New York, United States of America
| | - B Kantharia
- Mount Sinai St Luke's and Mount Sinai West Hospital, New York, United States of America
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Bhatia K, Ramirez R, Narasimhan B, Walsh S, Sud K, Uberoi G, Argulian E. Prognostic role of positron emission tomography in patients with known or suspected cardiac sarcoidosis. a systematic review and meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Sarcoidosis is a chronic inflammatory disorder of unclear etiology, characterized by the presence of non-caseating granulomas. Cardiac involvement occurs in upto 27 percent of patients, manifesting as atrioventricular blocks, ventricular arrhythmia or sudden cardiac death. Current guidelines cite insufficient evidence for the prognostic utility of positron emission tomography (PET) in patients with cardiac sarcoidosis. Thus, we performed a systematic review and meta-analysis of published studies to ascertain the prognostic significance of PET imaging in patients with suspected or diagnosed cardiac sarcoidosis.
Purpose
To review current literature and determine if PET has prognostic utility in patients with known or suspected cardiac sarcoidosis
Methods
We performed a comprehensive literature search of electronic databases (Embase, Medline and Web of Science) using MeSH terms and keywords for sarcoidosis and PET from inception through December 2019. Studies were eligible if they included patients with known and/or suspected cardiac sarcoidosis undergoing evaluation by PET with or without perfusion imaging and reported clinical events of interest. An abnormal PET study was defined as the presence of focal or focal-on-diffuse uptake of 18- fluorodeoxyglucose (18-FDG) by visual analysis. In studies with perfusion imaging, patients with only perfusion defects were excluded. The primary outcome of interest was a composite of major adverse cardiac events (MACE), including sustained ventricular tachycardia, sudden cardiac death. Secondary analysis studied association of MACE with focal right ventricular (RV) uptake in patients with an abnormal PET study. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Heterogeneity of results among the studies was assessed using the Higgins I2 value.
Results
Out of a total of 1645 citations, 40 were selected for full-text review. Five studies were included in the final analysis with a total of 465 patients. mean follow-up was 2.3 years. Three of the five studies also reported frequency of abnormal RV uptake of 18-FDG. Patients with abnormal 18-FDG uptake on visual assessment had higher odds of MACE (OR 3.12, CI 1.9–5.01, p<0.00001), compared to known or suspected cardiac sarcoid patients with normal PET studies. Heterogeneity among studies was low (I2 = 0). In patients with an abnormal PET study, abnormal focal RV uptake of 18-FDG was associated with higher odds of MACE (OR 5.24, CI 1.1–25.1, p=0.04), with moderate heterogeneity among studies (I2=41).
Conclusion
In patients undergoing PET imaging for known or suspected cardiac sarcoidosis, abnormal metabolism on visual analysis is associated with increased risk of MACE. Furthermore, focal RV uptake further increases the risk of MACE in patients with abnormal PET imaging. Thus, PET imaging can serve as a tool to risk stratify patients with known or suspected cardiac sarcoidosis.
Forrest Plots
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Bhatia
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
| | - R Ramirez
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
| | - B Narasimhan
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
| | - S Walsh
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - K Sud
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
| | - G Uberoi
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
| | - E Argulian
- Mount Sinai St Luke's and Mount Sinai West, New York, United States of America
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Abstract
Idiopathic spinal cord herniation is a rare but important and increasingly recognised cause of myelopathy seen in the thoracic spine. The factors that contribute to the aetiology of the condition and of the dural defect through which the cord herniates remain under debate. We discuss the clinical features and proposed pathophysiology of the condition, and illustrate key imaging findings on MRI, fluoroscopy and computed tomography (CT) myelography to establish the diagnosis, and discuss relevant differential diagnoses. Awareness and recognition of the condition is key as surgical intervention can improve outcomes for patients.
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Affiliation(s)
- K Bhatia
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK.
| | - A Madhavan
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK
| | - C Coutinho
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK
| | - S Mathur
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK.
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Fong P, Spampinato D, Hannah R, Rocchi L, Santo AD, Shoura M, Bhatia K, Rothwell J. P87 SICI: effect of conditioning stimulus orientation. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Okeke Ogwulu CB, Goranitis I, Devall AJ, Cheed V, Gallos ID, Middleton LJ, Harb HM, Williams HM, Eapen A, Daniels JP, Ahmed A, Bender-Atik R, Bhatia K, Bottomley C, Brewin J, Choudhary M, Deb S, Duncan WC, Ewer AK, Hinshaw K, Holland T, Izzat F, Johns J, Lumsden M, Manda P, Norman JE, Nunes N, Overton CE, Kriedt K, Quenby S, Rao S, Ross J, Shahid A, Underwood M, Vaithilingham N, Watkins L, Wykes C, Horne AW, Jurkovic D, Coomarasamy A, Roberts TE. The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM trial. BJOG 2020; 127:757-767. [PMID: 32003141 PMCID: PMC7187468 DOI: 10.1111/1471-0528.16068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. DESIGN Economic evaluation alongside a large multi-centre randomised placebo-controlled trial. SETTING Forty-eight UK NHS early pregnancy units. POPULATION Four thousand one hundred and fifty-three women aged 16-39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac. METHODS An incremental cost-effectiveness analysis was performed from National Health Service (NHS) and NHS and Personal Social Services perspectives. Subgroup analyses were carried out on women with one or more and three or more previous miscarriages. MAIN OUTCOME MEASURES Cost per additional live birth at ≥34 weeks of gestation. RESULTS Progesterone intervention led to an effect difference of 0.022 (95% CI -0.004 to 0.050) in the trial. The mean cost per woman in the progesterone group was £76 (95% CI -£559 to £711) more than the mean cost in the placebo group. The incremental cost-effectiveness ratio for progesterone compared with placebo was £3305 per additional live birth. For women with at least one previous miscarriage, progesterone was more effective than placebo with an effect difference of 0.055 (95% CI 0.014-0.096) and this was associated with a cost saving of £322 (95% CI -£1318 to £673). CONCLUSIONS The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable, especially for women who had one or more previous miscarriages. Given available evidence, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s). TWEETABLE ABSTRACT Progesterone treatment is likely to be cost-effective in women with early pregnancy bleeding and a history of miscarriage.
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Affiliation(s)
- C B Okeke Ogwulu
- Health Economics Unit, College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - I Goranitis
- Health Economics Unit, College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - A J Devall
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - V Cheed
- College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - I D Gallos
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - L J Middleton
- College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - H M Harb
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - H M Williams
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - A Eapen
- Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA
| | - J P Daniels
- Faculty of Medicine & Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - A Ahmed
- Sunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | | | - K Bhatia
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - C Bottomley
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - M Choudhary
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Deb
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - W C Duncan
- MRC Centre for Reproductive Health, the Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - A K Ewer
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - K Hinshaw
- Sunderland Royal Hospital, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - T Holland
- Guy's and St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - F Izzat
- University Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - J Johns
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - M Lumsden
- Academic Unit of Reproductive and Maternal Medicine, University of Glasgow, Glasgow, UK
| | - P Manda
- James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - J E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - N Nunes
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Isleworth, UK
| | - C E Overton
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - K Kriedt
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Quenby
- Biomedical Research Unit in Reproductive Health, University of Warwick, Warwick, UK
| | - S Rao
- Whiston Hospital, St Helen's and Knowsley Teaching Hospitals NHS Trust, Whiston, Prescot, UK
| | - J Ross
- Academic Unit of Reproductive and Maternal Medicine, University of Glasgow, Glasgow, UK
| | - A Shahid
- Whipps Cross Hospital, Barts Health NHS Trust, Leytonstone, London, UK
| | - M Underwood
- Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust, Apley, Telford, UK
| | - N Vaithilingham
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - L Watkins
- Liverpool Women's Hospital, Liverpool Women's NHS Foundation Trust, Liverpool Women's Hospital, Liverpool, UK
| | - C Wykes
- East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - A W Horne
- MRC Centre for Reproductive Health, the Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - D Jurkovic
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Coomarasamy
- College of Medical and Dental Sciences, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - T E Roberts
- Health Economics Unit, College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Allahwala U, Nour D, Alsanjari O, Bhatia K, Nagaraja V, Cockburn J, Hildick-Smith D, Sakata Y, Ward M, Weaver J, Bhindi R. 873 Rapid Recruitment of Coronary Collaterals During ST Elevation Myocardial Infarction (STEMI): A Meta-Analysis of Over 14,000 Patients. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Allahwala U, Nour D, Bhatia K, Ward M, Lo S, Weaver J, Bhindi R. 871 Prognostic Impact of Collaterals in Patients With a Coronary Chronic Total Occlusion (CTO): A Meta-Analysis of Over 3,000 Patients. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wilson-Baig N, Bhatia K, Kochhar P, Bonner S. Intrapartum spontaneous pneumomediastinum with subcutaneous emphysema - Management and recommendations to prevent recurrence in future pregnancies. Int J Obstet Anesth 2019; 41:122-124. [PMID: 31473015 DOI: 10.1016/j.ijoa.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/17/2022]
Affiliation(s)
- N Wilson-Baig
- Department of Anaesthesia, Manchester University Hospitals and Saint Mary's Hospital, Manchester, UK.
| | - K Bhatia
- Department of Anaesthesia, Manchester University Hospitals and Saint Mary's Hospital, Manchester, UK
| | - P Kochhar
- Department of Anaesthesia, Manchester University Hospitals and Saint Mary's Hospital, Manchester, UK
| | - S Bonner
- Department of Obstetrics and Maternal Medicine, Saint Mary's Hospital, Manchester, UK
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Chambers DJ, Bhatia K. In reply: Which anaesthesia for cesarean section in case of Horner's syndrome in women receiving epidural labor analgesia? Int J Obstet Anesth 2019; 38:149. [PMID: 30878173 DOI: 10.1016/j.ijoa.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 11/17/2022]
Affiliation(s)
- D J Chambers
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - K Bhatia
- Manchester University Hospital NHS Foundation Trust, St Mary's Hospital, Manchester, United Kingdom.
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Peprah S, Dhudha H, Ally H, Masalu N, Kawira E, Chao CN, Genga IO, Mumia M, Were PA, Kinyera T, Otim I, Legason ID, Biggar RJ, Bhatia K, Goedert JJ, Pfeiffer RM, Mbulaiteye SM. A population-based study of the prevalence and risk factors of low-grade Plasmodium falciparum malaria infection in children aged 0-15 years old in northern Tanzania. Trop Med Int Health 2019; 24:571-585. [PMID: 30843638 DOI: 10.1111/tmi.13225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/14/2022]
Abstract
OBJECTIVES Northern Tanzania experiences significant malaria-related morbidity and mortality, but accurate data are scarce. We update the data on patterns of low-grade Plasmodium falciparum malaria infection among children in northern Tanzania. METHODS Plasmodium falciparum malaria prevalence (pfPR) was assessed in a representative sample of 819 children enrolled in 94 villages in northern Tanzania between October 2015 and August 2016, using a complex survey design. Individual- and household-level risk factors for pfPR were elicited using structured questionnaires. pfPR was assessed using rapid diagnostic tests (RDTs) and thick film microscopy (TFM). Associations with pfPR, based on RDT, were assessed using adjusted odds ratios (aOR) and confidence intervals (CI) from weighted survey logistic regression models. RESULTS Plasmodium falciparum malaria prevalence (pfPR) was 39.5% (95% CI: 31.5, 47.5) by RDT and 33.4% (26.0, 40.6) by TFM. pfPR by RDT was inversely associated with higher-education parents, especially mothers (5-7 years of education: aOR 0.55; 95% CI: 0.31, 0.96, senior secondary education: aOR 0.10; 95% CI: 0.02, 0.55), living in a house near the main road (aOR 0.34; 95% CI: 0.15, 0.76), in a larger household (two rooms: aOR 0.40; 95% CI: 0.21, 0.79, more than two rooms OR 0.35; 95% CI: 0.20, 0.62). Keeping a dog near or inside the house was positively associated with pfPR (aOR 2.01; 95% CI: 1.26, 3.21). pfPR was not associated with bed-net use or indoor residual spraying. CONCLUSIONS Nearly 40% of children in northern Tanzania had low-grade malaria antigenaemia. Higher parental education and household metrics but not mosquito bed-net use were inversely associated with pfPR.
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Affiliation(s)
- S Peprah
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - H Dhudha
- Epidemiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) Study, Bugando Medical Center, Mwanza, Tanzania
| | - H Ally
- Epidemiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) Study, Bugando Medical Center, Mwanza, Tanzania
| | - N Masalu
- Epidemiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) Study, Bugando Medical Center, Mwanza, Tanzania
| | - E Kawira
- EMBLEM Study, Shirati Health and Educational Foundation, Shirati, Tanzania
| | - C N Chao
- Epidemiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) Study, Bugando Medical Center, Mwanza, Tanzania
| | - I O Genga
- EMBLEM Study, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - M Mumia
- EMBLEM Study, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - P A Were
- EMBLEM Study, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - T Kinyera
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda
| | - I Otim
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda
| | - I D Legason
- EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda
| | - R J Biggar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - K Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - J J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - R M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - S M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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Bahl A, Choudhary P, Bhatia K, Singhla S, Shrivastava G, Bal J, Anand A, Chaturvedi H. Palliative chemotherapy (CT) with or without cetuximab (CTX) in recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN): An Indian retrospective analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy438.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jacinto J, Bhidayasiri R, Chung T, Bhatia K, Landreau T, Colosimo C. Botulinum neurotoxin-A usage and training in cervical dystonia & spastic paresis: First results from the Ixcellence Network® survey. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chung T, Jacinto J, Bhatia K, Colosimo C, Landreau T, Bhidayasiri R. Improving management practices of cervical dystonia and spastic paresis: 5 years’ experience of Ixcellence Network®, an innovative international educational program. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chambers DJ, Bhatia K. Horner's syndrome following obstetric neuraxial blockade - a systematic review of the literature. Int J Obstet Anesth 2018; 35:75-87. [PMID: 29657082 DOI: 10.1016/j.ijoa.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
Horner's syndrome is a rarely reported complication of neuraxial blockade. In obstetric practice, the neurological signs of Horner's syndrome may cause anxiety amongst patients and healthcare staff, but more importantly may herald the onset of maternal hypotension. Medline, CINAHL, and EMBASE databases were searched to identify cases of Horner's syndrome following obstetric neuraxial blockade. Anaesthetic technique, clinical features, anaesthetic management of the Horner's syndrome and time to resolution were assessed. Seventy-eight case reports of Horner's syndrome following obstetric neuraxial blockade were identified. Nine cases also had trigeminal nerve palsy and one case had hypoglossal nerve palsy. Amongst the 78 cases, 74% developed Horner's syndrome within one hour of a local anaesthetic bolus. The median time for resolution of Horner's syndrome was two hours, though one case was permanent. One case of Horner's syndrome was found to be due to an internal carotid artery dissection. Some cases of Horner's syndrome resolved spontaneously despite ongoing administration of epidural local anaesthetic. Hypotension was reported in 13%. Horner's syndrome is usually a benign phenomenon, the consequence of high cephalad spread of local anaesthetic, that resolves spontaneously within a few hours. Patients with a persistent Horner's syndrome, or one associated with atypical features such as neck pain, should undergo a diagnostic workup including magnetic resonance angiography of the neck. The dermatomal level of neuraxial blockade, maternal and fetal well-being should be taken into account when making decisions regarding neuraxial blockade. The presence of Horner's syndrome alone should not lead to discontinuation of neuraxial blockade.
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Affiliation(s)
- D J Chambers
- Manchester University NHS Foundation Trust, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK
| | - K Bhatia
- Manchester University NHS Foundation Trust, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK.
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Golash M, Misfar N, Bhatia K. Minitouch Outpatient Endometrial Ablation – Learning Curve of 12 Gynaecologists. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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