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Flood R, Nunn AC, Talbott J, Cox A, Minks D, Wareham J, Crossley R, Malcolm G, Patel NK, Wigfield C, Williams A, Mortimer A. Initial experience using middle meningeal artery embolisation for patients with recurrent and high-recurrence-risk chronic subdural haematoma. J Clin Neurosci 2024; 125:126-131. [PMID: 38788605 DOI: 10.1016/j.jocn.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/02/2024] [Accepted: 05/19/2024] [Indexed: 05/26/2024]
Abstract
Recurrence rates following surgical management of chronic subdural haematoma (CSDH) range from 5 to 33 %. There is growing evidence which suggests middle meningeal artery embolisation (MMAe) may reduce recurrence rates when used as surgical adjunct or standalone treatment. In this study we described our experience of this new procedure in the our UK institution. Patients with recurrent CSDH or CSDH at high risk of recurrence were selected for MMAe on a case-by-case basis following MDT discussion. A departmental database was used to identify patients treated. 26 CSDH were embolised in 20 patients; 9 CSDH were de-novo and 17 were recurrent. 10/26 CSDH were treated with MMAe only. No procedural mortality, access site or thrombo-embolic complications occurred. One patient experienced symptomatic collection growth 12 h following MMAe and required surgical drainage. 15 (75 %) of patients were living at home at follow-up (mean 14 months). On imaging follow-up 15/18 showed CSDH volume reduction or resolution, 1/18 remained stable requiring no further treatment, 2/18 patients suffered recurrent CSDH requiring treatment. In both recurrent cases incomplete embolisation was noted on procedural imaging (posterior division of MMA not embolised). Persistent posterior MMA division filling was significantly associated with collection recurrence (p = 0.002). Our results suggest MMAe as a stand-alone or adjuvant therapy can be performed safely in a UK neuroscience setting and is associated with high rates of symptomatic CSDH size reduction or resolution in problematic CSDH that have either recurred or are prone to recurrence.
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Affiliation(s)
- R Flood
- Southmead Hospital, North Bristol NHS Trust, United Kingdom.
| | - A C Nunn
- Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - J Talbott
- Blackpool Victoria Hospital, Blackpool Teaching Hospital NHS Foundation Trust, United Kingdom
| | - A Cox
- Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - D Minks
- Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - J Wareham
- Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - R Crossley
- Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - G Malcolm
- Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - N K Patel
- Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - C Wigfield
- Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - A Williams
- Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - A Mortimer
- Southmead Hospital, North Bristol NHS Trust, United Kingdom
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Adelkhanova A, Oli PR, Shrestha DB, Shtembari J, Jha V, Shantha G, Bodziock GM, Biswas M, Zaman MO, Patel NK. Safety and efficacy of direct oral anticoagulants in comparison to warfarin in obese patients with atrial fibrillation: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e2044. [PMID: 38650729 PMCID: PMC11033493 DOI: 10.1002/hsr2.2044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aim Obesity affects nearly 650 million adults worldwide, and the prevalence is steadily rising. This condition has significant adverse effects on cardiovascular health, increasing the risk of hypertension, coronary artery disease, heart failure, and atrial fibrillation (AF). While anticoagulation for obese patients with AF is a well-established therapy for the prevention of thromboembolism, the safety and efficacy of different anticoagulants in this specific population are not well explored. This meta-analysis aimed to compare direct oral anticoagulants (DOAC) to vitamin K antagonists in obese populations with AF. Methods The PRISMA guidelines were followed for this meta-analysis, registered in PROSPERO (CRD42023392711). PubMed, PubMed Central, Embase, Cochrane Library, and Scopus databases were searched for relevant articles from inception through January 2023. Two independent authors screened titles and abstracts, followed by a full-text review in Covidence. Data were extracted in Microsoft Excel and analyzed using RevMan v5.4 using odds ratio as an effect measure. Results Two thousand two hundred fifty-nine studies were identified from the database search, and 18 were included in the analysis. There were statistically significant reductions in the odds of ischemic and hemorrhagic stroke in the DOAC group compared with the VKA group (OR 0.70, CI 0.66-0.75) and (OR 0.47, CI 0.35-0.62), respectively. In addition, the DOAC group exhibited lower odds of systemic embolism (OR 0.67, CI 0.54-0.83), major bleeding (OR 0.62, CI 0.54-0.72), and composite outcome (OR 0.72, CI 0.63-0.81). Conclusion Based on the findings from this meta-analysis, DOACs demonstrate superior safety and efficacy in obese patients with AF compared with VKAs. These results may have significant implications for guiding anticoagulation strategies in this patient population.
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Affiliation(s)
- Alla Adelkhanova
- Department of Internal MedicineMount Sinai HospitalChicagoIllinoisUSA
| | - Prakash Raj Oli
- Department of Internal MedicineProvince HospitalBirendranagarNepal
| | | | - Jurgen Shtembari
- Department of Internal MedicineMount Sinai HospitalChicagoIllinoisUSA
| | - Vivek Jha
- Department of Internal MedicineJohn H. Stroger, Jr. Hospital of Cook CountyChicagoIllinoisUSA
| | - Ghanshyam Shantha
- Department of Internal Medicine, Division of Cardiac ElectrophysiologyWake Forest University School of MedicineWinston SalemNorth CarolinaUSA
| | - George Michael Bodziock
- Department of Internal Medicine, Division of Cardiac ElectrophysiologyWake Forest University School of MedicineWinston SalemNorth CarolinaUSA
| | - Monodeep Biswas
- Department of Internal Medicine, Division of Cardiac ElectrophysiologyUniversity of Maryland Medical CenterBaltimoreMarylandUSA
| | - Muhammad Omer Zaman
- Department of Internal Medicine, Division of CardiologyRudd Heart HospitalLouisvilleKentuckyUSA
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Pondugula P, Krumme JW, Seedat R, Patel NK, Golladay GJ. Evaluation of painful total knee arthroplasty: an approach based on common etiologies for total knee arthroplasty revision. Musculoskelet Surg 2024; 108:11-20. [PMID: 37987959 DOI: 10.1007/s12306-023-00800-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/24/2023] [Indexed: 11/22/2023]
Abstract
A differential diagnosis with emphasis on the common indications for revision should be utilized in the workup of painful total knee arthroplasty (TKA). The physician should identify the exact etiology of the patient's pain to maximize outcomes from treatment. Evaluation for infection should be completed using the Musculoskeletal Infection Society (MSIS) criteria. When common causes of revision TKA do not appear to be the cause of the pain, less likely causes should be not be ignored. Further advancements such as pressure sensing devices may be able to improve patient satisfaction and decrease the incidence of pain following TKA.
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Affiliation(s)
- P Pondugula
- Department of Orthopedic Surgery, Virginia Commonwealth University Medical Center, PO Box 980153, Richmond, VA, 23298, USA
| | - J W Krumme
- Department of Orthopedic Surgery, Virginia Commonwealth University Medical Center, PO Box 980153, Richmond, VA, 23298, USA
| | - R Seedat
- Department of Orthopedic Surgery, Virginia Commonwealth University Medical Center, PO Box 980153, Richmond, VA, 23298, USA
| | - N K Patel
- Department of Orthopedic Surgery, Virginia Commonwealth University Medical Center, PO Box 980153, Richmond, VA, 23298, USA
| | - G J Golladay
- Department of Orthopedic Surgery, Virginia Commonwealth University Medical Center, PO Box 980153, Richmond, VA, 23298, USA.
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Shrestha DB, Sedhai YR, Oli PR, Proskuriakova E, Adelkhanova A, Shtembari J, Khan TMA, Singh K, Ahmed MA, Waheed I, Kazimuddin N, Steff R, Acharya R, Patel NK. Prior Use of Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers and Clinical Outcomes of Sepsis and Septic Shock: A Systematic Review and Meta-analysis. J Cardiovasc Pharmacol 2024; 83:16-22. [PMID: 37815234 DOI: 10.1097/fjc.0000000000001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023]
Abstract
ABSTRACT Sepsis and septic shock are life-threatening conditions that are associated with high mortality and considerable health care costs. The association between prior angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) use and outcomes after sepsis is elusive. The aim of this study was to evaluate the role of the prior use of ACEi or ARBs and outcomes after sepsis and septic shock. A relevant literature review was performed in 4 databases from inception until July 2022. Independent reviewers first screened the title, abstract, and full text, and then, data extraction and analysis were performed. One post hoc analysis of a trial and 6 retrospective cohort studies were included in this review. There were 22% lower odds of in-hospital/30-day mortality among patients who have used ACEi/ARBs in the past [23.83% vs. 37.20%; odds ratio (OR), 0.78, 95% confidence interval (CI), 0.64-0.96], and reduced 90-day mortality (OR, 0.80, 95% CI, 0.69-0.92). ACEi/ARBs users were found to have 31% lesser odds of developing acute kidney injury as compared with nonusers (OR, 0.69, 95% CI, 0.63-0.76). There was no significant difference in the length of hospital stay (MD 1.26, 95% CI, ‒7.89 to 10.42), need for renal replacement therapy (OR, 0.71, 95% CI, 0.13-3.92), mechanical ventilation (OR, 1.10, 95% CI, 0.88-1.37) or use of vasopressors (OR, 1.21, 95% CI, 0.91-1.61). Based on this analysis, prior use of ACEi/ARBs lowers the risk of mortality and adverse renal events in patients with sepsis and septic shock.
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Affiliation(s)
| | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Prakash Raj Oli
- Department of Internal Medicine, Province Hospital, Birendranagar, Nepal
| | | | - Alla Adelkhanova
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL
| | - Tahir Muhammad Abdullah Khan
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Karan Singh
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Muhammad Altaf Ahmed
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Irfan Waheed
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Nisarfathima Kazimuddin
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Rodney Steff
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY
| | - Roshan Acharya
- Department of Internal Medicine, Division of Pulmonary Disease and Critical Care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA; and
| | - Nimesh K Patel
- Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, School of Medicine, Richmond, VA
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Shtembari J, Shrestha DB, Awal S, Raut A, Gyawali P, Abe T, Patel NK, Deshmukh A, Voruganti D, Bhave PD, Whalen P, Pothineni NVK, Shantha G. Comparative assessment of safety with leadless pacemakers compared to transvenous pacemakers: a systemic review and meta-analysis. J Interv Card Electrophysiol 2023; 66:2165-2175. [PMID: 37106267 DOI: 10.1007/s10840-023-01550-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Leadless pacemakers (LP) and transvenous pacemakers (TVP) are two stable pacing platforms currently available in clinical practice. Observational data show mixed results with regards to their comparative safety. This meta-analysis was aimed to evaluate the comparative safety of LP over TVP. METHODS The study protocol was registered in PROSPERO registry (CRD42022325376). Six databases were searched for published literature from inception to April 12, 2022. RevMan 5.4.1 was used for statistical analysis. Odds ratio (OR) and mean difference were used to estimate the outcome with a 95% confidence interval (CI). RESULTS A total of 879 studies were imported from the databases. Among these, 41 papers were screened for full text and 17 meet the inclusion criteria. Among them, pooled results showed 42% lower odds of occurrence of complications in the LP group (OR 0.58, CI 0.42-0.80) compared to TVP group. Notably, 70% lower odds of device dislodgment (OR 0.30, CI 0.21-0.43), 46% lower odds of re-intervention (OR 0.54, CI 0.45-0.64), 87% lower odds of pneumothorax (OR 0.13, CI 0.03-0.57), albeit, 2.65 times higher odds of pericardial effusion (OR 2.65, CI 1.49-4.70) were observed in the LP group. CONCLUSIONS This meta-analysis showed LP to be a significantly safer modality compared to TVP, in terms of re-intervention, device dislodgment, pneumothoraxes, and overall complications. However, there were higher rates of pericardial effusion in the LP group. There was a diverse number of patients included, and all studies were observational. Randomized trials are needed to validate our findings.
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Affiliation(s)
- Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA
| | | | - Shila Awal
- Department of Internal Medicine, Suryabinayak Municipal Hospital, Suryabinayak, Nepal
| | - Anuradha Raut
- Department of Internal Medicine, Nepal Medical College, Kathmandu, Nepal
| | - Pratik Gyawali
- Department of Internal Medicine, Om Saibaba Memorial Hospital, Kathmandu, Nepal
| | - Temidayo Abe
- Department of Internal Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nimesh K Patel
- Department of Internal Medicine, Division of Cardiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Abhishek Deshmukh
- Department of Cardiology, Division of Electrophysiology, Mayo Clinic, Rochester, MN, USA
| | - Dinesh Voruganti
- Department of Internal Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Prashant Dattatraya Bhave
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Patrick Whalen
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | | | - Ghanshyam Shantha
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA.
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Shrestha DB, Dawadi S, Dhakal B, Shtembari J, Patel T, Shaikh R, Bodziock GM, Shantha G, Trankle CR, Patel NK. Direct oral anticoagulants (DOAC) versus vitamin K antagonist in left ventricular thrombus: An updated meta-analysis. Health Sci Rep 2023; 6:e1736. [PMID: 38028683 PMCID: PMC10667961 DOI: 10.1002/hsr2.1736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/29/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Aims Current clinical guidelines for treating left ventricular thrombus (LVT) are limited by inadequate evidence to inform the comparative efficacy of oral anticoagulants. In this meta-analysis, we aimed to compare the efficacy and safety of direct oral anticoagulants (DOAC) to vitamin K antagonists (VKA) in patients with LVT. Methods Four standard databases were searched for relevant literature comparing the efficacy and safety between DOAC and VKA for LVT treatment, published before August 19, 2023. Both the randomized controlled trials and observational studies were included in the analysis. The outcomes of interest were the resolution of LVT, all-cause mortality, stroke, systemic embolism, and bleeding. Data from the selected studies were extracted and analyzed using RevMan 5.4 using odds ratio. Results Among 3959 studies from the database search and bibliography review, 33 were included in the analysis. LVT resolution was observed in 72.59% in the DOAC group versus 67.49% in the VKA group (odds ratio [OR]: 1.28, confidence interval [CI]: 1.07-1.53). Mortality was lower in the DOAC group (11.71% vs. 18.56%) (OR: 0.60, CI: 0.36-1.00; borderline statistical significance). Likewise, bleeding events (9.60% vs. 13.19%) (OR: 0.65, CI: 0.52-0.81) and stroke (7.54% vs. 11.04%) (OR: 0.71, CI: 0.53-0.96) were also significantly lower in the DOAC group. Conclusion DOAC use for LVT showed better thrombus resolution and reduced risk of bleeding and stroke compared to VKA. Likewise, DOAC use was associated with lower mortality with borderline statistical significance.
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Affiliation(s)
- Dhan B. Shrestha
- Department of Internal MedicineMount Sinai HospitalChicagoIllinoisUSA
| | - Sagun Dawadi
- Department of Internal MedicineNepalese Army Institute of Health SciencesSanobharyangKathmanduNepal
| | - Bishal Dhakal
- Department of Internal MedicineNepalese Army Institute of Health SciencesSanobharyangKathmanduNepal
| | - Jurgen Shtembari
- Department of Internal MedicineMount Sinai HospitalChicagoIllinoisUSA
| | - Toralben Patel
- Department of Internal Medicine, Division of CardiologyAdventHealth ‐ AdventHealth Medical Group at East OrlandoOrlandoFloridaUSA
| | - Rafae Shaikh
- Department of CardiologyBon SecoursRichmondVirginiaUSA
| | - George M. Bodziock
- Department of Internal Medicine, Division of ElectrophysiologyAtrium Health Wake Forest Baptist Medical Center, Medical Center BoulevardWinston‐SalemNorth CarolinaUSA
| | - Ghanshyam Shantha
- Department of Internal Medicine, Division of ElectrophysiologyAtrium Health Wake Forest Baptist Medical Center, Medical Center BoulevardWinston‐SalemNorth CarolinaUSA
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Shrestha DB, Pathak BD, Thapa N, Shrestha O, Karki S, Shtembari J, Patel NK, Kapoor K, Kalahasty G, Bodziock G, Whalen P, Pothineni NVK, Narasimhan B, Koneru J, Shantha G. Catheter ablation using pulmonary vein isolation with versus without left atrial posterior wall isolation for persistent atrial fibrillation: an updated systematic review and meta-analysis. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01656-z. [PMID: 37773559 DOI: 10.1007/s10840-023-01656-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation of atrial fibrillation (AF); however, the results are suboptimal for persistent AF. The left atrial posterior wall (LAPW) is thought to be a major additional area in initiation and perpetuation of persistent AF. Therefore, adjunctive ablation of the posterior wall may reduce AF recurrence in patients with persistent AF. OBJECTIVE The objective of this study was to compare outcomes of catheter ablation in patients with persistent AF using PVI alone versus a combination of PVI and LAPW isolation. METHODS Literature search was conducted in PubMed, PubMed Central, Scopus, and Embase since inception to February 2023. Screening of studies was done via Covidence software. Risk of bias assessment was done using appropriate tools. Data extraction and a narrative synthesis were carried out accordingly. RESULTS Ten studies were included, of which five were randomized controlled trials. PVI with LAPW ablation group had significantly lower recurrence of overall atrial tachyarrhythmia (OR 0.47, CI 0.32-0.70) and AF (OR 0.39, CI 0.23-0.69). In sensitivity analysis, freedom from atrial arrhythmias was noted to be significantly higher in the PVI with LAPW ablation group (OR 2.22, CI 1.36-3.64). However, there was no significant difference in occurrence of atrial flutter (OR 1.36, CI 0.86-2.14) or with periprocedural adverse events (OR 1.10, CI 0.60-1.99). CONCLUSION LAPW ablation, in addition to PVI, significantly improves the rates of arrhythmia freedom and reduces the recurrence of overall atrial tachyarrhythmia. There was no significant difference in atrial flutter or periprocedural adverse events.
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Affiliation(s)
| | - Bishnu Deep Pathak
- Department of Internal Medicine, Jibjibe Primary Health Care Center, Rasuwa, Nepal
| | - Niranjan Thapa
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Oshan Shrestha
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Sagun Karki
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA
| | - Nimesh K Patel
- Department of Internal Medicine, Division of Cardiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Kunal Kapoor
- Department of Internal Medicine, Division of Cardiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Gautham Kalahasty
- Department of Internal Medicine, Division of Electrophysiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - George Bodziock
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Patrick Whalen
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | | | - Bharat Narasimhan
- Department of Cardiology, Debakey Cardiovascular Institute, Houston Methodist, Houston, TX, USA
| | - Jayanthi Koneru
- Department of Internal Medicine, Division of Electrophysiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ghanshyam Shantha
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
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Tantrige P, Patel KV, Patel NK, Haque S, Leung R, Naz F, Allen P, Blake H, Yusuf GT, Sidhu PS. Ultrasound simulation training to meet the 2021 Royal College of Radiologists' curriculum for radiology trainees: South East London experience. Clin Radiol 2023; 78:671-678. [PMID: 37336673 DOI: 10.1016/j.crad.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/12/2023] [Accepted: 05/16/2023] [Indexed: 06/21/2023]
Abstract
AIM To enhance ultrasound teaching delivery to radiology trainees using a simulation course matched to the 2021 Royal College of Radiologists (RCR) curriculum. MATERIAL AND METHODS An ultrasound simulation training course was designed for specialty trainees (ST) 1 in radiology, which was based on the 2021 RCR curriculum and covered the top ultrasound training priorities. The course was piloted initially on two occasions in a 1-day format to the August 2021 and the March 2022 ST1 intake trainees. Based on the feedback, a comprehensive 4-day course was developed and delivered between October and December 2022 for the August 2022 ST1 intake, funded by Health Education England. The outcomes measured were subjective trainee feedback using numerical scores and free text. RESULTS All King's College Hospital NHS Foundation Trust radiology ST1 trainees from the August 2021 to the August 2022 intake participated in ultrasound simulation training. The training matched the RCR curriculum and increased the trainees' confidence and competency in medical ultrasound. CONCLUSIONS Ultrasound simulation training can be successfully delivered to ST1 trainees to match the 2021 RCR curriculum and enhance training in medical ultrasound for radiologists.
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Affiliation(s)
- P Tantrige
- Department of Radiology, King's College Hospital NHS Foundation Trust, UK.
| | - K V Patel
- Department of Radiology, Croydon University Hospital, UK
| | - N K Patel
- Department of Radiology, King's College Hospital NHS Foundation Trust, UK
| | - S Haque
- Department of Radiology, King's College Hospital NHS Foundation Trust, UK
| | - R Leung
- Department of Radiology, King's College Hospital NHS Foundation Trust, UK
| | - F Naz
- Department of Radiology, King's College Hospital NHS Foundation Trust, UK
| | - P Allen
- Department of Radiology, King's College Hospital NHS Foundation Trust, UK
| | - H Blake
- Department of Radiology, Croydon University Hospital, UK
| | - G T Yusuf
- Department of Radiology, King's College Hospital NHS Foundation Trust, UK
| | - P S Sidhu
- Department of Radiology, King's College Hospital NHS Foundation Trust, UK
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9
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Shrestha B, Shrestha DB, Sedhai YR, Shtembari J, Oli PR, Shikhrakar S, Paudel B, Roberts M, Patel NK, Singh A, Singh K, Waheed I, Basnyat S, Khan MS, Kazimuddin M, Elgendy IY. Differences in treatment and outcomes among patients with ST-segment elevation myocardial infarction with and without standard modifiable risk factors: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:2916-2923. [PMID: 37363488 PMCID: PMC10289527 DOI: 10.1097/ms9.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/19/2023] [Indexed: 06/28/2023] Open
Abstract
There are limited data available on outcomes and pathophysiology behind ST-segment elevation myocardial infarction (STEMI) in populations without standard modifiable risk factors (SMuRFs). The authors carried out this meta-analysis to understand the differences in treatment and outcomes of STEMI patients with and without SMuRFs. Methods A systematic database search was performed for relevant studies. Studies reporting desired outcomes among STEMI patients with and without SMuRFs were selected based on predefined criteria in the study protocol (PROSPERO: CRD42022341389). Two reviewers independently screened titles and abstracts using Covidence. Full texts of the selected studies were independently reviewed to confirm eligibility. Data were extracted from all eligible studies via a full-text review of the primary article for qualitative and quantitative analysis. In-hospital mortality following the first episode of STEMI was the primary outcome, with major adverse cardiovascular events (MACE), repeat myocardial infarction (MI), cardiogenic shock, heart failure, and stroke as secondary outcomes of interest. Odds ratio (OR) with a 95% CI was used to estimate the effect. Results A total of 2135 studies were identified from database search, six studies with 521 150 patients with the first STEMI episode were included in the analysis. The authors found higher in-hospital mortality (OR: 1.43; CI: 1.40-1.47) and cardiogenic shock (OR: 1.59; 95% CI: 1.55-1.63) in the SMuRF-less group with no differences in MACE, recurrent MI, major bleeding, heart failure, and stroke. There were lower prescriptions of statin (OR: 0.62; CI: 0.42-0.91) and Angiotensin converting enzyme inhibitor /Angiotensin II receptor blocker (OR: 0.49; CI: 0.28-0.87) at discharge in SMuRF-less patients. There was no difference in procedures like coronary artery bypass graft, percutaneous coronary intervention, and thrombolysis. Conclusion In the SMuRF-less STEMI patients, higher in-hospital mortality and treatment discrepancies were noted at discharge.
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Affiliation(s)
| | | | - Yub R. Sedhai
- Department of Internal Medicine, Division of Pulmonary Disease and Critical Care, University of Kentucky College of Medicine-Bowling Green Campus, Bowling Green, Kentucky
| | | | - Prakash R. Oli
- Department of Internal Medicine, Province Hospital, Birendranagar, Surkhet
| | - Shreeja Shikhrakar
- Department of Internal Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - Bidhya Paudel
- Department of Internal Medicine, AMITA Health, Ascension Saint Francis, Evanston, Illinois
| | - Madhur Roberts
- Department of Internal Medicine, Division of Cardiology, Tulane University, New Orleans, Louisiana
| | - Nimesh K. Patel
- Department of Internal Medicine, Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Aniruddha Singh
- Department of Internal Medicine, Division of Cardiology, Tower Health Program, West Reading, Pennsylvania
| | - Karan Singh
- Department of Internal Medicine, Division of Pulmonary Disease and Critical Care, University of Kentucky College of Medicine-Bowling Green Campus, Bowling Green, Kentucky
| | - Irfan Waheed
- Department of Internal Medicine, Division of Pulmonary Disease and Critical Care, University of Kentucky College of Medicine-Bowling Green Campus, Bowling Green, Kentucky
| | - Soney Basnyat
- Department of Internal Medicine, University of Kentucky College of Medicine-Bowling Green Campus
| | - Mohammad S. Khan
- Department of Internal Medicine, Division of Cardiology, University of Kentucky College of Medicine-Bowling Green Campus, Bowling Green
| | - Mohammed Kazimuddin
- Department of Internal Medicine, Division of Cardiology, University of Kentucky College of Medicine-Bowling Green Campus, Bowling Green
| | - Islam Y. Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington
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10
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Shrestha DB, Sedhai YR, Dawadi S, Dhakal B, Shtembari J, Singh K, Acharya R, Basnyat S, Waheed I, Khan MS, Kazimuddin M, Patel NK, Kalahasty G, Bhave PD, Whalen P, Shantha G. Outcome of In-Hospital Cardiac Arrest among Patients with COVID-19: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12082796. [PMID: 37109134 PMCID: PMC10144838 DOI: 10.3390/jcm12082796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/10/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Outcomes following in-hospital cardiac arrest (IHCA) in patients with COVID-19 have been reported by several small single-institutional studies; however, there are no large studies contrasting COVID-19 IHCA with non-COVID-19 IHCA. The objective of this study was to compare the outcomes following IHCA between COVID-19 and non-COVID-19 patients. METHODS We searched databases using predefined search terms and appropriate Boolean operators. All the relevant articles published till August 2022 were included in the analyses. The systematic review and meta-analysis were conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. An odds ratio with a 95% confidence interval (CI) was used to measure effects. RESULTS Among 855 studies screened, 6 studies with 27,453 IHCA patients (63.84% male) with COVID-19 and 20,766 (59.7% male) without COVID-19 were included in the analysis. IHCA among patients with COVID-19 has lower odds of achieving return of spontaneous circulation (ROSC) (OR: 0.66, 95% CI: 0.62-0.70). Similarly, patients with COVID-19 have higher odds of 30-day mortality following IHCA (OR: 2.26, 95% CI: 2.08-2.45) and have 45% lower odds of cardiac arrest because of a shockable rhythm (OR: 0.55, 95% CI: 0.50-0.60) (9.59% vs. 16.39%). COVID-19 patients less commonly underwent targeted temperature management (TTM) or coronary angiography; however, they were more commonly intubated and on vasopressor therapy as compared to patients who did not have a COVID-19 infection. CONCLUSIONS This meta-analysis showed that IHCA with COVID-19 has a higher mortality and lower rates of ROSC compared with non-COVID-19 IHCA. COVID-19 is an independent risk factor for poor outcomes in IHCA patients.
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Affiliation(s)
| | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Sagun Dawadi
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu 44600, Nepal
| | - Bishal Dhakal
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu 44600, Nepal
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA
| | - Karan Singh
- Division of Pulmonary Disease and Critical Care, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Roshan Acharya
- Division of Pulmonary Disease and Critical Care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA 24014, USA
| | - Soney Basnyat
- Department of Internal Medicine, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Irfan Waheed
- Division of Pulmonary Disease and Critical Care, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Mohammad Saud Khan
- Division of Cardiology, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Mohammed Kazimuddin
- Division of Cardiology, University of Kentucky College of Medicine-Bowling Green Campus, E 1st Ave, Bowling Green, KY 42101, USA
| | - Nimesh K Patel
- Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA 23219, USA
| | - Gautham Kalahasty
- Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA 23219, USA
| | - Prashant Dattatraya Bhave
- Department of Internal Medicine, Division of Electrophysiology, Atrium Health Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Patrick Whalen
- Department of Internal Medicine, Division of Electrophysiology, Atrium Health Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Ghanshyam Shantha
- Department of Internal Medicine, Division of Electrophysiology, Atrium Health Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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11
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Gouldin AG, Patel NK, Golladay GJ, Puetzer JL. Advanced glycation end-product accumulation differs by location and sex in aged osteoarthritic human menisci. Osteoarthritis Cartilage 2023; 31:363-373. [PMID: 36494052 PMCID: PMC10088070 DOI: 10.1016/j.joca.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is a clear link between increasing age and meniscus degeneration, leading to increased injury, osteoarthritis (OA) progression, and often total knee replacement. Advanced glycation end-products (AGEs) are non-enzymatic crosslinks and adducts that accumulate in collagen with age, altering tissue mechanics and cell function, ultimately leading to increased injury and inflammation. AGEs, both fluorescent and non-fluorescent, play a central role in age-related degradation of tissues throughout the body; however, little is known about their role in meniscus degeneration. The objective of this study was to characterize changes in aged OA menisci, specifically evaluating zonal AGE accumulation, to gain a better understanding of changes that may lead to age-related meniscal degeneration. METHOD Deidentified human menisci (N = 48, 52-84 years old) were obtained from subjects undergoing total knee replacement. Changes in extracellular matrix (ECM) were assessed by gross morphology, confocal analysis, and biochemical assays. Deoxyribonucleic acid (DNA), glycosaminoglycan (GAG), collagen, and AGE accumulation were compared with patient age, zonal region, and patient sex. RESULTS There were minimal changes in DNA, GAG, and collagen concentration with age or zone. However, collagen fraying and AGEs increased with age, with more AGEs accumulating in the meniscal horns compared to the central body and in male menisci compared to females. CONCLUSIONS Overall, this work provides greater insights into regional changes that occur in human menisci with age and OA. These results suggest AGEs may play a role in the degeneration of the meniscus, with AGEs being a possible target to reduce age-related tears, degeneration, and OA progression.
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Affiliation(s)
- A G Gouldin
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States.
| | - N K Patel
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, United States.
| | - G J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, United States.
| | - J L Puetzer
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States; Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, United States.
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12
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Johnsen P, Satpathy J, Patel NK, Hansen E, Mounasamy V. Antegrade femoral nailing in the lateral decubitus position: a case series, technical tips and review of literature. Eur J Orthop Surg Traumatol 2023; 33:381-384. [PMID: 35024951 DOI: 10.1007/s00590-021-03200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Femoral intramedullary nailing is traditionally performed with the patient supine on a fracture table. We aimed to describe a case series of femoral intramedullary nailing for fracture in the lateral position, with discussion of the operative technique. METHODS A retrospective analysis identified 52 patients who underwent femoral intramedullary nailing performed in a lateral position without traction over a 5-year period at a single level 1 trauma center. Medical records were reviewed for demographics, blood loss including need for transfusion, operative duration, complications, length of stay, fracture union, re-operation and death. RESULTS There were 24 subtrochanteric, 16 peri-trochanteric and 12 diaphyseal femoral fractures. Mean operative time was 136.2 ± 101.4 min with a mean estimated blood loss of 372.5 ± 349.6 ml. Seventeen patients required blood transfusion. Mean length of stay was 10.3 ± 8.1 days. There were 3 (5.8%) surgical (compartment syndrome, infection and retained drain) and 12 (23.1%) medical complications, with a 30-day mortality rate of 3.8% (2). Mean follow-up was 9.9 ± 8.7 months. The union rate was 94.2% (49) and 3.8% (2) patients required revision fixation (hardware exchange for irritation and exchange nailing for non-union). Discharge destination was home, rehabilitation center and specialized nursing facility in 21 (40.4%), 16 (30.8%) and 15 (28.8%) patients, respectively. DISCUSSION AND CONCLUSION Femoral intramedullary nailing in the lateral decubitus position is a useful technique of managing peri-trochanteric, subtrochanteric and diaphyseal femoral fractures. We describe a known technique with technical tips, which has distinct advantages over traditional supine positioning especially in certain patient and fracture types. In addition, operative times, blood loss, length of stay, revision and outcomes were comparable to the literature.
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Affiliation(s)
- P Johnsen
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - J Satpathy
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - N K Patel
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - E Hansen
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - V Mounasamy
- Virginia Commonwealth University, Richmond, VA, USA.
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13
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Abdelaal A, Reda A, Lashin BI, Katamesh BE, Brakat AM, AL-Manaseer BM, Kaur S, Asija A, Patel NK, Basnyat S, Rabaan AA, Alhumaid S, Albayat H, Aljeldah M, Shammari BRA, Al-Najjar AH, Al-Jassem AK, AlShurbaji ST, Alshahrani FS, Alynbiawi A, Alfaraj ZH, Alfaraj DH, Aldawood AH, Sedhai YR, Mumbo V, Rodriguez-Morales AJ, Sah R. Preventing the Next Pandemic: Is Live Vaccine Efficacious against Monkeypox, or Is There a Need for Killed Virus and mRNA Vaccines? Vaccines (Basel) 2022; 10:vaccines10091419. [PMID: 36146497 PMCID: PMC9500691 DOI: 10.3390/vaccines10091419] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/18/2022] [Accepted: 08/26/2022] [Indexed: 11/27/2022] Open
Abstract
(1) Background: The monkeypox virus (MPV) is a double-stranded DNA virus belonging to the Poxviridae family, Chordopoxvirinae subfamily, and Orthopoxvirus genus. It was called monkeypox because it was first discovered in monkeys, in a Danish laboratory, in 1958. However, the actual reservoir for MPV is still unknown. (2) Methods and Results: We have reviewed the existing literature on the options for Monkeypox virus. There are three available vaccines for orthopoxviruses—ACAM2000, JYNNEOS, and LC16—with the first being a replicating vaccine and the latter being non- or minimally replicating. (3) Conclusions: Smallpox vaccinations previously provided coincidental immunity to MPV. ACAM2000 (a live-attenuated replicating vaccine) and JYNNEOS (a live-attenuated, nonreplicating vaccine) are two US FDA-approved vaccines that can prevent monkeypox. However, ACAM2000 may cause serious side effects, including cardiac problems, whereas JYNNEOS is associated with fewer complications. The recent outbreaks across the globe have once again highlighted the need for constant monitoring and the development of novel prophylactic and therapeutic modalities. Based on available data, there is still a need to develop an effective and safe new generation of vaccines specific for monkeypox that are killed or developed into a mRNA vaccine before monkeypox is declared a pandemic.
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Affiliation(s)
- Abdelaziz Abdelaal
- Postgraduate Medical Education, Harvard Medical School, Boston, MA 02115, USA
- School of Medicine, Boston University, Boston, MA 02118, USA
- Tanta Research Team, Tanta 31527, Egypt
- Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Abdullah Reda
- Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | | | - Basant E. Katamesh
- Tanta Research Team, Tanta 31527, Egypt
- Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Aml M. Brakat
- Faculty of Medicine, Zagazig University, Ash Sharqia Governorate, Zagazig 44519, Egypt
| | - Balqees Mahmoud AL-Manaseer
- Jordan University Hospital, Amman 11942, Jordan
- School of Medicine, University of Jordan, Amman 11733, Jordan
| | - Sayanika Kaur
- Department of Internal Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Ankush Asija
- Department of Internal Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Nimesh K. Patel
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Soney Basnyat
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia
| | - Hawra Albayat
- Infectious Disease Department, King Saud Medical City, Riyadh 11564, Saudi Arabia
| | - Mohammed Aljeldah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 39831, Saudi Arabia
| | - Basim R. Al Shammari
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 39831, Saudi Arabia
| | - Amal H. Al-Najjar
- Drug & Poison Information Center, Pharmacy Department, Security Forces Hospital Program, Riyadh 11564, Saudi Arabia
| | - Ahmed K. Al-Jassem
- Drug & Poison Information Center, Pharmacy Department, Security Forces Hospital Program, Riyadh 11564, Saudi Arabia
| | - Sultan T. AlShurbaji
- Outpatient Pharmacy, Dr. Sulaiman Alhabib Medical Group, Diplomatic Quarter, Riyadh 91877, Saudi Arabia
| | - Fatimah S. Alshahrani
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ahlam Alynbiawi
- Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | - Zainab H. Alfaraj
- Department of Nursing, Maternity and Children Hospital, Dammam 31176, Saudi Arabia
| | - Duaa H. Alfaraj
- Department of Nursing, Maternity and Children Hospital, Dammam 31176, Saudi Arabia
| | - Ahmed H. Aldawood
- Molecular Diagnostic Laboratory, Dammam Regional Laboratory and Blood Bank, Dammam 31411, Saudi Arabia
| | - Yub Raj Sedhai
- Division of Pulmonary Diseases and Critical Care Medicine, University of Kentucky, Bowling Green, KY 40292, USA
| | - Victoria Mumbo
- Coast General Teaching and Referral Hospital, Mombasa P.O. Box 90231-80100, Kenya
| | - Alfonso J. Rodriguez-Morales
- Latin American Network on Monkeypox Virus Research (LAMOVI), Pereira 66001, Colombia
- Institución Universitaria Visión de las Américas, Pereira 12998, Colombia
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónomade las Américas, Pereira 66003, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima 4861, Peru
| | - Ranjit Sah
- Postgraduate Medical Education, Harvard Medical School, Boston, MA 02115, USA
- Latin American Network on Monkeypox Virus Research (LAMOVI), Pereira 66001, Colombia
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu 44600, Nepal
- Correspondence: or ; Tel.: +977-9803098857
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14
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Mojaddedi S, Palaiodimos L, Esmati S, Patel NK, Mojadidi MK. Patent foramen ovale device closure for patients with stroke and high-risk PFO morphology. Heart Vessels 2022; 38:869-870. [PMID: 35986751 DOI: 10.1007/s00380-022-02156-2] [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: 06/27/2022] [Accepted: 08/17/2022] [Indexed: 11/04/2022]
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15
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Mojaddedi S, Esmati S, Patel NK, Tobis JM, Mojadidi MK. Atrial fibrillation after patent foramen ovale device closure: Protecting from one embolic stroke etiology but causing another? Catheter Cardiovasc Interv 2022; 100:774-775. [PMID: 35830721 DOI: 10.1002/ccd.30330] [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: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Sanaullah Mojaddedi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Saliman Esmati
- Department of Medicine, Jamaica Hospital Medical Center, Queens, New York, USA
| | - Nimesh K Patel
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jonathan M Tobis
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Mohammad K Mojadidi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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16
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Shrestha DB, Budhathoki P, Sedhai Y, Khadka M, Pokharel S, Yadav S, Patel T, Elgendy I, Mir WAY, Patel NK. Colchicine for Patients With Coronary Artery Disease: A Systematic Review and Meta-analysis. J Cardiovasc Pharmacol 2022; 79:420-430. [PMID: 34935703 DOI: 10.1097/fjc.0000000000001200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Several randomized controlled trials have studied the role of colchicine, a potent anti-inflammatory drug, to prevent adverse cardiovascular events in patients with coronary artery disease (CAD). In this meta-analysis, we aimed to determine the role of colchicine in patients with CAD in clinical outcomes and mortality. We searched PubMed, PubMed Central, Scopus, and Embase for randomized controlled trials/experimental studies evaluating the role of colchicine in patients with CAD. After assessing the eligibility for inclusion, risk-of-bias assessment, and data extraction from the included studies, a narrative synthesis was conducted. Of 17 studies included for the qualitative analysis, 11 studies reported that inflammatory markers such as C-reactive protein and cytokines were reduced in the colchicine group, suggesting an anti-inflammatory role of colchicine in CAD. Quantitative analysis with pooling of data from 9 studies using a fixed-effect model showed 28% lower odds of acute myocardial infarction [odds ratio (OR) 0.72, 95% CI 0.59-0.86; n = 11,712], 52% lower occurrence of stroke (OR 0.48, 95% CI 0.30-0.76), and 37% reduction in odds of coronary revascularization procedure in the colchicine group (OR 0.63, 95% CI 0.52-0.76; n= 11,258). However, the odds of gastrointestinal adverse events were 50% higher in the colchicine group (OR 1.50, 95% CI 1.01-2.23; n = 12,214). In conclusion, colchicine is associated with a lower risk of acute myocardial infarction, stroke, and coronary revascularization. However, there is some increased risk of gastrointestinal adverse events with the use of colchicine.
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Affiliation(s)
- Dhan B Shrestha
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL
| | | | - YubRaj Sedhai
- Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA
| | - Manoj Khadka
- Nepalese Army Institute of Health Sciences (NAIHS), Kathmandu, Nepal
| | | | - Stuti Yadav
- Nepalese Army Institute of Health Sciences (NAIHS), Kathmandu, Nepal
| | - Toralben Patel
- Department of Internal Medicine, Division of Cardiology, AdventHealth-AdventHealth Medical Group at East Orlando, Orlando, FL
| | - Islam Elgendy
- Department of Internal Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar ; and
| | | | - Nimesh K Patel
- Department of Internal Medicine, Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, School of Medicine, Richmond, VA
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17
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Sedhai YR, Patel NK, Mihalick V, Talasaz A, Thomas G, Denlinger BL, Damonte JI, Del Buono MG, Federmann E, Hardin M, Ibe I, Harmon M, Van Tassell B, Abbate A. Heart failure clinical trial enrollment at a rural satellite hospital. Contemp Clin Trials 2022; 115:106731. [PMID: 35283262 PMCID: PMC9647921 DOI: 10.1016/j.cct.2022.106731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Heart failure is a clinical condition that notably affects the lives of patients in rural areas. Partnering of a rural satellite hospital with an urban academic medical center may provide geographically underrepresented populations with heart failure an opportunity to access to controlled clinical trials (CCTs). METHODS We report our experience in screening, consenting and enrolling subjects at the VCU Health Community Memorial Hospital (VCU-CMH) in rural South Hill, Virginia, that is part of the larger VCU Health network, with the lead institution being VCU Health Medical College of Virginia Hospitals (VCU-MCV), Richmond, VA. Subjects were enrolled in a clinical trial sponsored by the National Institutes of Health and assigned to treatment with an anti-inflammatory drug for heart failure or placebo. We used the electronic health record and remote guidance and oversight from the VCU-MCV resources using a close-loop communication network to work with local resources at the facility to perform screening, consenting and enrollment. RESULTS One hundred subjects with recently decompensated heart failure were screened between January 2019 and August 2021, of these 61 are enrolled to date: 52 (85%) at VCU-MCV and 9 (15%) at VCU-CMH. Of the subjects enrolled at VCU-CMH, 33% were female, 77% Black, with a mean age of 52 ± 10 years. CONCLUSION The use of a combination of virtual/remote monitoring and guidance of local resources in this trial provides an opportunity for decentralization and access of CCTs for potential novel treatment of heart failure to underrepresented individuals from rural areas. TRIAL REGISTRATION ClinicalTrials.gov: NCT03797001.
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Affiliation(s)
- Yub Raj Sedhai
- VCU Health, Community Memorial Hospital, , South Hill, VA, United States of America
| | - Nimesh K Patel
- VCU Health, Community Memorial Hospital, , South Hill, VA, United States of America; VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Virginia Mihalick
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Azita Talasaz
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Georgia Thomas
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Bethany L Denlinger
- VCU Health, Community Memorial Hospital, , South Hill, VA, United States of America; VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Juan I Damonte
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Marco Giuseppe Del Buono
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Emily Federmann
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Mary Hardin
- VCU Health, Community Memorial Hospital, , South Hill, VA, United States of America
| | - Ikenna Ibe
- VCU Health, Community Memorial Hospital, , South Hill, VA, United States of America
| | - Mary Harmon
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Benjamin Van Tassell
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Antonio Abbate
- VCU Health, Medical College of Virginia Hospital, Virginia Commonwealth University, Richmond, VA, United States of America.
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18
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Shrestha DB, Budhathoki P, Sedhai YR, Karki P, Gurung S, Raut S, Damonte JI, Del Buono MG, Mojadidi MK, Elgendy IY, Patel T, Patel NK. Sodium-glucose cotransporter-2 Inhibitors in Heart Failure: An Updated Systematic Review and Meta-analysis of 13 Randomized Clinical Trials Including 14,618 Patients With Heart Failure. J Cardiovasc Pharmacol 2021; 78:501-514. [PMID: 34269700 DOI: 10.1097/fjc.0000000000001099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Sodium-glucose cotransporter-2 (SGLT-2) inhibitors showed benefit in patients with heart failure. In this updated meta-analysis, we evaluate the therapeutic efficacy and safety of SGLT-2 inhibitors in patients with heart failure. Different electronic databases were searched to find relevant articles. RevMan 5.4 was used for pooling data using a random/fixed-effects model, complemented by several sensitivity and subgroup analyses. A total of 13 randomized clinical trials including 14,618 patients with heart failure were included in analysis among 6797 studies screened. The overall mortality rate was 12.45% in the SGLT-2 group and 14.67% in the placebo group with 18% lower odds of overall mortality [odds ratio (OR), 0.82; confidence interval (CI), 0.75-0.91] in the SGLT-2 group. Odds of cardiovascular mortality was 18% lower (OR, 0.82; CI, 0.74-0.92) in the SGLT-2 group. The odds of hospitalization for heart failure (HHF) was 38% lower during the study period (OR, 0.62; CI, 0.56-0.68) in the SGLT-2 group. In addition, a benefit was seen for composite outcome HHF or mortality and considering subgrouping based on diabetes status, gender, and age groups. Although genital infection was significantly higher in the SGLT-2 group, the occurrence of severe adverse events, hypoglycemia, urinary tract infection, bone fracture, volume depletion, and other renal events did not differ between the 2 groups. Thus, SGLT-2 inhibitors improved cardiovascular outcomes among patients with heart failure with no significant difference in adverse events. Clinical benefit was comparable in diabetic and nondiabetic individuals, males and females, people in younger and older age groups with underlying heart failure, and HF with reduced ejection fraction.
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Affiliation(s)
| | | | - Yub Raj Sedhai
- Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA
| | - Parag Karki
- Department of Internal Medicine, Division of Cardiology, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Kathmandu, Nepal
| | - Suja Gurung
- Department of Intensive Care Unit, Dirghayu Guru Hospital and Research Center, Chabahil, Kathmandu, Nepal
| | - Sumit Raut
- Department of Emergency Medicine, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - Juan Ignacio Damonte
- Department of Internal Medicine, Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, School of Medicine, Richmond, VA
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Argentina
| | - Marco Giuseppe Del Buono
- Department of Internal Medicine, Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, School of Medicine, Richmond, VA
| | - Mohammad Khalid Mojadidi
- Department of Internal Medicine, Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, School of Medicine, Richmond, VA
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Qatar ; and
| | - Toralben Patel
- Department of Internal Medicine, Division of Cardiology, AdventHealth - AdventHealth Medical Group at East Orlando, 258 South Chickasaw Trail Suite 203, Orlando, FL
| | - Nimesh K Patel
- Department of Internal Medicine, Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, School of Medicine, Richmond, VA
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Elgendy AY, Saver JL, Amin Z, Boudoulas KD, Carroll JD, Elgendy IY, Grunwald IQ, Gertz ZM, Hijazi ZM, Horlick EM, Kasner SE, Kent DM, Kumar P, Kavinsky CJ, Liebeskind DS, Lutsep H, Mojadidi MK, Messé SR, Mas JL, Mattle HP, Meier B, Mahmoud A, Mahmoud AN, Nietlispach F, Patel NK, Rhodes JF, Reisman M, Sommer RJ, Sievert H, Søndergaard L, Zaman MO, Thaler D, Tobis JM. Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale-Associated Stroke. JAMA Neurol 2021; 77:878-886. [PMID: 32282016 DOI: 10.1001/jamaneurol.2020.0458] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Recent epidemiologic and therapeutic advances have transformed understanding of the role of and therapeutic approach to patent foramen ovale (PFO) in ischemic stroke. Patent foramen ovale is likely responsible for approximately 5% of all ischemic strokes and 10% of those occurring in young and middle-aged adults. Observations Randomized clinical trials have demonstrated that, to prevent recurrent ischemic stroke in patients with PFO and an otherwise-cryptogenic index ischemic stroke, PFO closure is superior to antiplatelet medical therapy alone; these trials have provided some evidence that, among medical therapy options, anticoagulants may be more effective than antiplatelet agents. Conclusions and Relevance These new data indicate a need to update classification schemes of causative mechanisms in stroke, developed in an era in which an association between PFO and stroke was viewed as uncertain. We propose a revised general nomenclature and classification framework for PFO-associated stroke and detailed revisions for the 3 major stroke subtyping algorithms in wide use.
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Affiliation(s)
- Akram Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Jeffrey L Saver
- Comprehensive Stroke Center, David Geffen School of Medicine, Department of Neurology, University of California, Los Angeles, Los Angeles
| | - Zahid Amin
- Children's Hospital of Georgia, Department of Pediatric Cardiology, Augusta University, Augusta, Georgia
| | | | - John D Carroll
- Division of Cardiology, Department of Medicine, University of Colorado, Denver, Aurora
| | - Islam Y Elgendy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Iris Q Grunwald
- Cardiovascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, United Kingdom
| | - Zachary M Gertz
- Division of Cardiovascular Medicine, Department of Medicine, Virginia Commonwealth University, Richmond
| | - Ziyad M Hijazi
- Sidra Heart Center, Sidra Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Eric M Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Scott E Kasner
- Perelman School of Medicine, Department of Neurology, University of Pennsylvania, Philadelphia
| | - David M Kent
- Department of Neurology, Tufts University School of Medicine, Boston, Massachusetts
| | - Preetham Kumar
- David Geffen School of Medicine, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles
| | | | - David S Liebeskind
- Comprehensive Stroke Center, David Geffen School of Medicine, Department of Neurology, University of California, Los Angeles, Los Angeles
| | - Helmi Lutsep
- Department of Neurology, Oregon Health & Science University, Portland
| | - Mohammad K Mojadidi
- Division of Cardiovascular Medicine, Department of Medicine, Virginia Commonwealth University, Richmond
| | - Steven R Messé
- Perelman School of Medicine, Department of Neurology, University of Pennsylvania, Philadelphia
| | - Jean-Louis Mas
- Sainte-Anne Hospital, Department of Neurology, Département Hospitalo-Universitaire NeuroVasc Sorbonne Paris-Cité, Institut National de la Santé et de la Recherche Médicale 894, Paris, France
| | - Heinrich P Mattle
- Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Ahmad Mahmoud
- Department of Medicine, University of Florida, Gainesville
| | - Ahmed N Mahmoud
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle
| | - Fabian Nietlispach
- CardioVascular Center Zurich, Hirslanden Klinik Im Park, Zürich, Switzerland
| | - Nimesh K Patel
- Division of Cardiovascular Medicine, Department of Medicine, Virginia Commonwealth University, Richmond
| | | | - Mark Reisman
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle
| | - Robert J Sommer
- Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center, Columbia University Medical Center, New York, New York
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, United Kingdom
| | | | | | - David Thaler
- Department of Neurology, Tufts University School of Medicine, Boston, Massachusetts
| | - Jonathan M Tobis
- David Geffen School of Medicine, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles
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Patel T, Baydoun H, Patel NK, Tripathi B, Nanavaty S, Savani S, Mojadidi MK, Agarwal N, Patel G, Patel S, Pancholy S. Peripheral Arterial Disease in Women: The Gender Effect. Cardiovascular Revascularization Medicine 2020; 21:404-408. [DOI: 10.1016/j.carrev.2019.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/19/2019] [Accepted: 05/28/2019] [Indexed: 02/08/2023]
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21
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Patel NK, Ahmed H. P265 Infective endocarditis:think global, act local:changing trends in infective endocarditis-integrating antibiotic stewardship program: data from developing world. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Despite improvements in diagnostic and therapeutic strategies, both the incidence, severity & mortality of Infective Endocarditis (IE) seem to be unchanged.The pattern of the disease in terms of host, agent & environment changing rapidly.The successful integration of antibiotic stewardship program along with the appropriate use of antibiotic agents has made a huge difference in the treatment strategy & cost reduction in patient care for IE. Materials & Methods: A single centre, retrospective & prospective study done between 2009 to 2018. The diagnosis of infective endocarditis was done as per the modified Duke’s Criteria. 355 patients were analysed and baseline demographic data with echocardiographic, microbiologic,complications, treatment & outcomes noted. All blood cultures processing was done with BACTEC and BacTAlert using standard precautions.Antibiotic stewardship program was initiated since February 2016 as per international protocol. Results: The mean age of the study population was 46.7+-3 years. Predominanlty streptococcus species ( 21.4%) was isolated in the culture.A definite rise in atypical (17.9%) organism was noted in 2018 over the period of study as compared to 2009 : Presence of Burkholderia, Candida, Atypical Mycobacterium spp increased. Despite the advances in diagnostic modalities,there has been no change in mortality associated with IE (10.3%) over the period of 2009-2018. There is a predominantly native Mitral Valve involvement (53.7%) & a definite rise in Prosthetic Valve endocarditis (19.6%) noted in the last 5 years. Conclusion:This study is the largest study & data on Infective Endocarditis so far from a single centre in a developing world with a study population of 355 patients. Risk factors for IE have changed over time.Newer paradigms in treating IE and integration of antibiotic stewardship program has successfully brought down the cost and increased care in this part of the developing world.
Changing trends : Organism Profile in IE Year Strept(%) Staph(%) Entero(%) Atypical(%) 2009 26.2 2.4 7.1 7.1 2011 24 8 12 16 2013 20 10 10 17.5 2015 27.3 12.7 3.6 20 2016 13.6 31.8 4.5 18.2 2017 27.6 13.8 10.3 34.5 2018 21.4 17.9 10.7 17.9
Abstract P265 Figure. Changing Epidemiological trends in IE
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Affiliation(s)
- N K Patel
- Amrita Institute of Medical Sciences (AIMS), Adult Cardiology, Kochi, India
| | - H Ahmed
- Amrita Institute of Medical Sciences (AIMS), Adult Cardiology, Kochi, India
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Roberts VLH, Bailey M, Patel NK. The safety and efficacy of neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking in 168 horses. Equine Vet J 2019; 52:238-243. [PMID: 31461784 PMCID: PMC7317358 DOI: 10.1111/evj.13174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 07/27/2019] [Indexed: 01/01/2023]
Abstract
Background Early results from the use of neuromodulation by percutaneous electrical nerve stimulation for the management of trigeminal‐mediated headshaking in horses were promising but lacked sufficient case numbers and long‐term follow‐up. The neuromodulatory procedure has since been established as EquiPENS™. Objectives The aim of this study was to report long‐term results from a larger number of cases and to investigate for predictors of outcome. Study design Prospective case series using international, multi‐centre data. Methods Eligible cases were horses with a veterinary diagnosis of trigeminal‐mediated headshaking, which received EquiPENS™ neuromodulation at trained centres between August 2013 and November 2017. The standard protocol was an initial three‐procedure course, with additional procedures should a horse go into remission but then relapse. Data collected included signalment, history, diagnostic tests performed, details of any complications, whether horses had gone into remission and the length of remission. Results Results were obtained from 168 horses, with 530 procedures. The complication rate was 8.8% of procedures. In all but one case, complications were mild and transient, without self‐trauma. Remission of headshaking following the initial course occurred in 53% (72/136) of horses. Median length of time recorded in remission was 9.5 weeks (range 2 days to 156 weeks ongoing). Where signs recurred, most horses went back into remission following additional procedures, usually for longer than from the previous procedure. No predictors for outcome were determined. Main limitations No placebo or control group, owner‐assessed results. Conclusions EquiPENS™ neuromodulation can be an effective and safe treatment for the management of trigeminal‐mediated headshaking in some horses. An increased understanding of neuromodulation could help optimise the technique. Advances in treatment for trigeminal‐mediated headshaking will remain limited until there is a greater understanding of the aetiopathogenesis of the condition.
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Affiliation(s)
- V L H Roberts
- Bristol Veterinary School, University of Bristol, Somerset, UK
| | - M Bailey
- Bristol Veterinary School, University of Bristol, Somerset, UK
| | | | - N K Patel
- Institute of Neurosciences, Southmead Hospital Bristol, Westbury-on-Trym, Bristol, UK
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23
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Mojadidi MK, Zaman MO, Elgendy IY, Mahmoud AN, Patel NK, Agarwal N, Tobis JM, Meier B. Cryptogenic Stroke and Patent Foramen Ovale. J Am Coll Cardiol 2019; 71:1035-1043. [PMID: 29495983 DOI: 10.1016/j.jacc.2017.12.059] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/30/2017] [Accepted: 12/22/2017] [Indexed: 02/09/2023]
Abstract
Nearly one-half of patients with cryptogenic stroke have a patent foramen ovale (PFO). The dilemma of whether to close these PFOs percutaneously, in an effort to reduce the risk of recurrent paradoxical embolism, has been a matter of ongoing debate for more than a decade. Early randomized clinical trials failed to demonstrate a significant benefit of percutaneous PFO closure for secondary prevention of cryptogenic stroke in an intention-to-treat analysis. The long-term follow-up data from the RESPECT trial and 2 new randomized trials (CLOSE and REDUCE) have clarified these findings. They showed that with good patient selection, transcatheter PFO closure significantly reduces the risk of recurrent stroke compared with medical therapy in patients with cryptogenic stroke, with no increased risk of serious adverse events or influence on major bleeding.
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Affiliation(s)
- Mohammad K Mojadidi
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Muhammad O Zaman
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Islam Y Elgendy
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Ahmed N Mahmoud
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Nimesh K Patel
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Nayan Agarwal
- Interventional Cardiology, Cardiovascular Institute of the South, Houma, Louisiana
| | - Jonathan M Tobis
- Program in Interventional Cardiology, Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
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24
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Mojadidi MK, Mahmoud AN, Mahtta D, Zaman MO, Elgendy IY, Elgendy AY, Agarwal N, Patel NK, Gertz ZM, Wayangankar SA, Lew DC, Jneid H, Don CW, Meier B, Tobis JM. Incidence and Causes of 30-day Readmissions after Surgical Versus Percutaneous Secundum Atrial Septal Defect Closure: A United States Nationwide Analysis. Structural Heart 2019. [DOI: 10.1080/24748706.2018.1559963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Mohammad K. Mojadidi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ahmed N. Mahmoud
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dhruv Mahtta
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Muhammad O. Zaman
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Islam Y. Elgendy
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Akram Y. Elgendy
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Nayan Agarwal
- Interventional Cardiology, Cardiovascular Institute of the South, Houma, Louisiana, USA
| | - Nimesh K. Patel
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary M. Gertz
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Siddharth A. Wayangankar
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - David C. Lew
- Florida Heart and Vascular Center, Leesburg, Florida, USA
| | - Hani Jneid
- Division of Cardiology and Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Creighton W. Don
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Jonathan M. Tobis
- Program in Interventional Cardiology, Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
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25
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Zaman MO, Patel NK, Mojadidi MK. Patent foramen ovale closure for patients excluded from the randomized cryptogenic stroke trials. Clin Res Cardiol 2018; 107:1187-1188. [PMID: 29955915 DOI: 10.1007/s00392-018-1305-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/19/2018] [Accepted: 06/15/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Muhammad O Zaman
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.,Division of Cardiovascular Medicine, Department of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Nimesh K Patel
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mohammad K Mojadidi
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
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26
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Mojadidi MK, Zaman MO, Patel NK. Letter by Mojadidi et al Regarding Article, "Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack: Updated Systematic Review and Meta-Analysis". Stroke 2018; 49:e212. [PMID: 29643255 DOI: 10.1161/strokeaha.118.021403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Mohammad K Mojadidi
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Muhammad O Zaman
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville
| | - Nimesh K Patel
- Division of Cardiovascular Medicine, Department of Medicine, Virginia Commonwealth University, Richmond
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27
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Zaman MO, Patel NK, Mojadidi MK. Letter by Zaman et al Regarding Article, “Safety Outcomes After Percutaneous Transcatheter Closure of Patent Foramen Ovale”. Stroke 2018; 49:e16. [DOI: 10.1161/strokeaha.117.019571] [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: 11/16/2022]
Affiliation(s)
- Muhammad Omer Zaman
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville
| | - Nimesh K. Patel
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond
| | - Mohammad K. Mojadidi
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville
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Abstract
Consent to autopsy is usually obtained by a doctor other than the one who will perform the procedure. There is an argument that, for proper informed consent, a pathologist should participate. We ascertained the views of consultant pathologists in south-east England. 53 (87%) of 61 consultants responded, of whom 50 currently do autopsies. Only 2 at present participate directly in obtaining consent, and 10 of the remaining 48 expressed willingness to do so. The general view was that consent is best obtained by a senior clinician from the team that has looked after the patient. Pathologists see their primary role as to provide guidance to clinicians. Few see it as their function to obtain consent for autopsy.
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Affiliation(s)
- A T Williams
- Department of Histopathology, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
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29
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Mojadidi MK, Elgendy AY, Elgendy IY, Mahmoud AN, Elbadawi A, Eshtehardi P, Patel NK, Wayangankar S, Tobis JM, Meier B. Transcatheter Patent Foramen Ovale Closure After Cryptogenic Stroke. JACC Cardiovasc Interv 2017; 10:2228-2230. [DOI: 10.1016/j.jcin.2017.09.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/17/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
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Sabharwal S, Patel NK, Griffiths D, Athanasiou T, Gupte CM, Reilly P. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysis. Bone Joint Res 2016; 5:470-480. [PMID: 27756738 PMCID: PMC5086838 DOI: 10.1302/2046-3758.510.2000638] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 08/08/2016] [Indexed: 01/16/2023] Open
Abstract
Objectives The objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes. Methods A systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed. Results Seven studies including 528 patients were included. The overall meta-analysis found that there was no difference in clinical outcomes. However, subgroup and sensitivity analyses found improved patient outcomes for more complex fractures managed surgically. Four-part fractures that underwent surgery had improved long-term health utility scores (mean difference, MD 95% CI 0.04 to 0.28; p = 0.007). They were also less likely to result in osteoarthritis, osteonecrosis and non/malunion (OR 7.38, 95% CI 1.97 to 27.60; p = 0.003). Another significant subgroup finding was that secondary surgery was more common for patients that underwent internal fixation compared with conservative management within the studies with predominantly three-part fractures (OR 0.15, 95% CI 0.04 to 0.63; p = 0.009). Conclusion This meta-analysis has demonstrated that differences in the type of fracture and surgical treatment result in outcomes that are distinct from those generated from analysis of all types of fracture and surgical treatments grouped together. This has important implications for clinical decision making and should highlight the need for future trials to adopt more specific inclusion criteria. Cite this article: S. Sabharwal, N. K. Patel, D. Griffiths, T. Athanasiou, C. M. Gupte, P. Reilly. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysisBone Joint Res 2016;5:470–480. DOI: 10.1302/2046-3758.510.2000638.
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Affiliation(s)
- S Sabharwal
- Virginia Commonwealth University Medical Centre, Richmond, Virginia, USA
| | - N K Patel
- Virginia Commonwealth University Medical Centre, Richmond, Virginia, USA
| | - D Griffiths
- Imperial College London, 1022, Queen Elizabeth the Queen Mother Wing (QEQM), St Mary's Campus, London, UK
| | - T Athanasiou
- Imperial College London, 1022, Queen Elizabeth the Queen Mother Wing (QEQM), St Mary's Campus, London, UK
| | - C M Gupte
- Department of Trauma and Orthopaedics, St Mary's Hospital, Ground Floor Salton House, South Wharf Road, London, W2 1NY, UK
| | - P Reilly
- Department of Trauma and Orthopaedics, St Mary's Hospital, Ground Floor Salton House, South Wharf Road, London, W2 1NY, UK
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Chen A, Patel NK, Khan Y, Cobb JP, Gupte CM. The cost of adverse events from knee surgery in the United Kingdom: an in-depth review of the National Health Service Litigation Authority database. Knee 2015; 22:286-91. [PMID: 26006772 DOI: 10.1016/j.knee.2015.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 01/20/2015] [Revised: 04/14/2015] [Accepted: 04/21/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND There has been a significant rise in the number and value of claims against the National Health Service (NHS), with limited studies on litigation in orthopaedic surgery and none in knee surgery alone. We aimed to examine claims against the NHS involving all aspects of knee surgery with respect to costs and trends. CLINICAL RELEVANCE To raise awareness of the reasons for litigation in knee surgery, thus potentially improve patient care and reduce future claims. METHODS We analysed the NHS litigation authority (NHSLA) database for all orthopaedic surgery claims reported to the NHSLA between 2005 and 2010, with calculation of litigation success rates and odds ratios for those relating to knee surgery. RESULTS There were 515 cases identified from the 4609 orthopaedic cases in the NHSLA database (11.2%): 298 (58%) involving total knee replacements (TKRs), 11 (2%) involving unicondylar knee replacements, and 90 cases (30%) remaining open. The total pay out for closed cases was £10.45 million and amputation following TKR resulted in the highest single pay out. Litigation success rates for claimants were highest for retained drains (100%), incorrect prosthesis/prosthesis size (78%), renal failure (75%), poor outcome requiring further surgery (74%) and malalignment (71%). There were also 60 cases of delayed diagnosis which resulted in pay outs totalling £2.90 million. Based on these data, projected future pay out costs for the open TKR cases were estimated to be £2.71 million. CONCLUSION Litigation success rates for TKR were highest following technical errors such as malalignment compared to events less under the surgeon's control, such as infection. The number of claims involving incorrect prosthesis/size continues to be of concern. Despite the increased availability of imaging modalities, missed diagnosis also resulted in substantial pay outs.
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Affiliation(s)
- A Chen
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - N K Patel
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
| | - Y Khan
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - J P Cobb
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - C M Gupte
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
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Nguyen AD, Heil EL, Patel NK, Duffy A, Gilmore S. A single-center evaluation of the risk for colonization or bacteremia with piperacillin-tazobactam- and cefepime-resistant bacteria in patients with acute leukemia receiving fluoroquinolone prophylaxis. J Oncol Pharm Pract 2015; 22:303-7. [PMID: 25567517 DOI: 10.1177/1078155214567161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fluoroquinolone prophylaxis is indicated to prevent neutropenic fever in patients with acute leukemia. However, fluoroquinolone use has been associated with development of multi-drug-resistant Pseudomonas aeruginosa and extended spectrum β-lactamase producing gram-negative bacilli. Due to a presumed risk of multi-drug resistance associated with fluoroquinolone prophylaxis, patients admitted to our hospital with neutropenic fever receive empiric carbapenem therapy until cultures are negative for 72 h or identification of an organism. Our study seeks to identify the incidence of multi-drug-resistant organism colonization and bacteremia among patients who receive fluoroquinolone prophylaxis and to evaluate duration of empiric carbapenem therapy. A retrospective review of adult patients with acute leukemia receiving a fluoroquinolone as outpatient infection prophylaxis, admitted to our tertiary cancer center for treatment of neutropenic fever was completed. Surveillance and blood cultures were reviewed for antibiotic resistance. Duration of empiric carbapenem therapy was reviewed. One hundred patients and 177 admissions for neutropenic fever were included. Six patients harbored a piperacillin-tazobactam-resistant organism found during routine surveillance. Among these patients, two bacteremias were identified, one of which was a piperacillin-tazobactam-resistant organism. Five bacteremias were identified among 83 patients with negative surveillance cultures. Among the bloodstream infections, five organisms isolated were fluoroquinolone resistant. No cefepime-resistant organism was isolated on surveillance or bloodstream cultures. Adherence to the institution guideline of narrowing antibiotics after 72 h of negative cultures occurred in only 13% of neutropenic fever cases. The average duration of carbapenem therapy in 177 neutropenic fever episodes was 4.4 days. Our findings show that among our patient population, there is a low risk of bacteremia with a piperacillin-tazobactam-resistant or cefepime-resistant organism. However, prompt de-escalation of carbapenem therapy needs to be reiterated within hospital practice.
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Affiliation(s)
- A D Nguyen
- University of Maryland Medical Center, Baltimore, USA
| | - E L Heil
- University of Maryland Medical Center, Baltimore, USA
| | - N K Patel
- University of Maryland School of Pharmacy, Baltimore, USA
| | - A Duffy
- University of Maryland School of Pharmacy, Baltimore, USA
| | - S Gilmore
- University of Maryland Medical Center, Baltimore, USA
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Abstract
INTRODUCTION Few studies have reported the outcome of hip resurfacing arthroplasty (HRA) with respect to implant characteristics from non-specialist centres. We report the survival, clinical and radiological outcomes of a single surgeon series of HRA with an average follow-up duration of five years. METHODS All consecutive HRAs performed by a single surgeon between 2003 and 2011 at a district general hospital were retrospectively examined clinically and radiologically. RESULTS A total of 85 patients underwent 109 HRAs (58 male [53.2%] and 51 female patients [46.8%]) with a mean follow-up period of 62 months (range: 12-102 months). The median age was 57 years (range: 25-75 years). The mean acetabular and femoral head component sizes were 54 mm (range: 48-64 mm) and 48 mm (range: 42-58 mm) respectively with a mean acetabular inclination angle of 42.9° (range: 20-75°). The survival rate was 95% with five revisions due to aseptic loosening (n=3) and fracture (n=2): these were predominantly for female patients (n=4), with significantly smaller mean acetabular (51 mm, p=0.04) and femoral (44 mm, p=0.02) implant sizes. Furthermore, they had a higher mean acetabular inclination angle of 48.1° (p=0.74). The mean Oxford hip score was 43.8 (range: 25-48) and the mean University of California Los Angeles (UCLA) activity score was 6.8 (range: 3-10). Radiological findings included heterotopic ossification in 13 (11.9%), radiolucent lines in 6 (5.5%), femoral neck thinning in 2 (1.8%) and femoral neck notching in 5 patients (4.6%). CONCLUSIONS We have shown that HRA at a non-specialist centre has short to medium-term outcomes comparable with those at specialist centres. HRA therefore remains a viable option although vigilance is required in case selection and follow-up according to national guidance.
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Affiliation(s)
- N K Patel
- Department of Trauma and Orthopaedic Surgery, Barnet and Chase Farm NHS Trust, Barnet, Hertfordshire, UK.
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Thevendran G, Sarraf KM, Patel NK, Sadri A, Rosenfeld P. The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg 2013; 97:9-20. [PMID: 23546858 DOI: 10.1007/s12306-013-0251-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 03/21/2013] [Indexed: 06/02/2023]
Abstract
The Achilles tendon (AT) is the most frequently ruptured tendon in the human body yet the aetiology remains poorly understood. Despite the extensively published literature, controversy still surrounds the optimum treatment of complete rupture. Both non-operative management and percutaneous repair are attractive alternatives to open surgery, which carries the highest complication and cost profile. However, the lack of a universally accepted scoring system has limited any evaluation of treatment options. A typical UK district general hospital treats approximately 3 cases of AT rupture a month. It is therefore important for orthopaedic surgeons to correctly diagnose and treat these injuries with respect to the best current evidence-based practice. In this review article, we discuss the relevant pathophysiology and diagnosis of the ruptured AT and summarize the current evidence for treatment.
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Affiliation(s)
- G Thevendran
- Department of Trauma and Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Patel NK, Windley J, Naique S. Atraumatic posterior dislocation of the native hip: an unusual presentation of septic arthritis. Musculoskelet Surg 2012; 98:81-3. [PMID: 22684539 DOI: 10.1007/s12306-012-0205-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
Abstract
We present a case of chronic posterior hip dislocation after severe joint destruction following septic arthritis. In the absence of trauma, infection must be considered in the differential diagnosis of a dislocated joint particularly in patients with risk factors such as intravenous drug abuse and immune compromise. Excision arthroplasty of the hip was performed with good pain relief and functional outcomes. This is an excellent temporary or permanent solution in managing such complex cases although alternative management options are discussed.
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Affiliation(s)
- N K Patel
- Department of Trauma and Orthopaedic Surgery, Charing Cross Hospital, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK,
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Patel NK, Bajekal RA. A simple minimally invasive technique of removing lumbar disc debris following discectomy. Ann R Coll Surg Engl 2012. [PMID: 22613313 PMCID: PMC3957514 DOI: 10.1308/003588412x13171221591259g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- N K Patel
- Barnet and Chase Farm Hospitals NHS Trust, UK.
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Patel NK, Bajekal RA. A simple minimally invasive technique of removing lumbar disc debris following discectomy. Ann R Coll Surg Engl 2012; 94:277. [DOI: 10.1308/rcsann.2012.94.4.277] [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: 11/22/2022] Open
Affiliation(s)
- NK Patel
- Barnet and Chase Farm Hospitals NHS TrustUK
| | - RA Bajekal
- Barnet and Chase Farm Hospitals NHS TrustUK
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Affiliation(s)
- N K Patel
- Department of Neurosurgery, Institute of Neurosciences, Frenchay Hospital, Bristol, UK.
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Gunturi SB, Theerthala SS, Patel NK, Bahl J, Narayanan R. Prediction of skin sensitization potential using D-optimal design and GA-kNN classification methods. SAR QSAR Environ Res 2010; 21:305-335. [PMID: 20544553 DOI: 10.1080/10629361003773955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Modelling of skin sensitization data of 255 diverse compounds and 450 calculated descriptors was performed to develop global predictive classification models that are applicable to whole chemical space. With this aim, we employed two automated procedures, (a) D-optimal design to select optimal members of the training and test sets and (b) k-Nearest Neighbour classification (kNN) method along with Genetic Algorithms (GA-kNN Classification) to select significant and independent descriptors in order to build the models. This methodology helped us to derive multiple models, M1-M5, that are stable and robust. The best among them, model M1 (CCR(train) = 84.3%, CCR(test) = 87.2% and CCR(ext) = 80.4%), is based on six neighbours and nine descriptors and further suggests that: (a) it is stable and robust and performs better than the reported models in literature, and (b) the combination of D-optimal design and GA-kNN classification approach is a very promising approach. Consensus prediction based on the models M1-M5 improved the CCR of training, test and external validation datasets by 3.8%, 4.45% and 3.85%, respectively, over M1. From the analysis of the physical meaning of the selected descriptors, it is inferred that the skin sensitization potential of small organic compounds can be accurately predicted using calculated descriptors that code for the following fundamental properties: (i) lipophilicity, (ii) atomic polarizability, (iii) shape, (iii) electrostatic interactions, and (iv) chemical reactivity.
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Affiliation(s)
- S B Gunturi
- Innovation Labs Hyderabad, Tata Consultancy Services Limited, #1, Software Units Layout, Madhapur, Hyderabad - 500 081, India
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Trivedi SV, Vasava AH, Bhatia LC, Patel TC, Patel NK, Patel NT. Plasma exchange with immunosuppression in pulmonary alveolar haemorrhage due to leptospirosis. Indian J Med Res 2010; 131:429-433. [PMID: 20418558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND & OBJECTIVES Pulmonary involvement due to leptospirosis carries high case fatality rate and is the commonest cause of death due to leptospirosis. Immune mechanisms play a key role in the pathogenesis of leptospiral pulmonary haemorrhage. As other immune pulmonary haemorrhages due to non leptospiral causes are treated with plasma exchange and cyclophosphamide we evaluated their efficacy in patient with leptospiral pulmonary haemorrhage. METHODS Of the 602 confirmed patients of leptospirosis, 236 (39.2%) had pulmonary haemorrhage. Of these,144 had mild haemorrhage (acute lung injury score < 2.5) and were included in the study. One hundred and fourteen patients were given two cycles of plasma exchange, 24 h apart, 25 ml/kg body weight of plasma was removed in each cycle. Cyclophosphamide (20 mg/kg body weight) was given after the first plasma exchange cycle. The remaining 30 patients were not given this treatment, and used as control. RESULTS In the control group only 5 (16.6%) patients survived while in the treatment group 70 (61.40%) patients survived. Thrombocytopenia was observed in 111 (77.08%) patients. Renal and hepatic involvement was seen but did not account for mortality. Minor complications were seen in group I patients after plasma exchange and cyclophosphamide treatment, but none were serious. INTERPRETATION & CONCLUSIONS Our findings showed that plasma exchange with immunosuppression improved survival in patients of pulmonary alveolar haemorrhage due to leptospirosis, suggesting that immune mechanisms play a key role in the pathogenesis of the disease.
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Affiliation(s)
- Samir V Trivedi
- Department of Medicine, Government Medical College, Surat, India.
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Gibbins J, Steeds C, Greenslade GL, Tunstall SR, Patel NK, Stannard CF. To replace or not to replace? - Partial coning and a sixth nerve palsy secondary due to displacement of a tunnelled intrathecal catheter for pain control. Palliat Med 2008; 22:668-70. [PMID: 18612034 DOI: 10.1177/0269216308091558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/15/2022]
Abstract
We report the displacement of a tunnelled intrathecal catheter causing significant cerebrospinal fluid (CSF) leak, resulting in partial coning and a sixth nerve palsy. The patient had advanced malignant mesothelioma and all other methods of pain control had been unsuccessful. As far as we are aware, there are no published reports of early replacement of an intrathecal catheter in patients with neurological sequelae. Surgical re-siting of the intrathecal catheter produced good pain relief for many months. Doctors involved in the use of indwelling intrathecal catheters for pain control must be aware of the risk of significant neurological sequelae but should not dismiss re-establishment of intrathecal therapy in the presence of significant neurological complications.
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Affiliation(s)
- J Gibbins
- The Macmillan Unit, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol, UK.
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Abstract
The mainstays of Parkinson's disease (PD) treatment remain symptomatic, including initial dopamine replacement and subsequent deep brain stimulation, however, neither of these approaches is neuroprotective. Neurotrophic factors - proteins that activate cell signalling pathways regulating neuronal survival, differentiation, growth and regeneration - represent an alternative for treating dopaminergic neurons in PD but are difficult to administer clinically because they do not pass through the blood-brain barrier. Glial cell line-derived neurotrophic factor (GDNF) has potent neurotrophic effects particularly but not exclusively on dopaminergic neurons; in animal models of PD, it has consistently demonstrated both neuroprotective and neuroregenerative effects when provided continuously, either by means of a viral vector or through continuous infusion either into the cerebral ventricles (ICV) or directly into the denervated putamen. This led to a human PD study in which GDNF was administered by monthly bolus intracerebroventricular injections, however, no clinical benefit resulted, probably because of the limited penetration to the target brain areas, and instead significant side effects occurred. In an open-label study of continuous intraputamenal GDNF infusion in five patients (one unilaterally and four bilaterally), we reported excellent tolerance, few side effects and clinical benefit evident within three months of the commencement of treatment. The clinical improvement was sustained and progressive, and by 24-months patients demonstrated a 57 and 63% improvement in their off-medication motor and activities of daily living UPDRS subscores, respectively, with clear benefit in dyskinesias. The benefit was associated with a significant increase in putamenal 18F-dopa uptake on positron emission tomography (PET), and in one patient coming to autopsy after 43 months of unilateral infusion there was evident increased tyrosine hydroxylase immunopositive nerve fibres in the infused putamen. A second open trial in 10 patients using unilateral intraputamenal GDNF infusions has also demonstrated a greater than 30% bilateral benefit in both on- and off-medication scores at 24 weeks. Based on our 6-month results, a randomized controlled clinical trial was conducted to confirm the open-label results, however, GDNF infusion over 6-months did not confer the predetermined level of clinical benefit to patients with PD despite increased 18F-dopa uptake surrounding the catheter tip. It is possible that technical differences between this trial and the positive open label studies contributed to this negative outcome.
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Affiliation(s)
- N K Patel
- Institute of Neurosciences, Frenchay Hospital, Bristol, UK
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MESH Headings
- Aged
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/therapeutic use
- Biopsy
- Deglutition Disorders/diagnosis
- Deglutition Disorders/drug therapy
- Deglutition Disorders/etiology
- Deglutition Disorders/pathology
- Diagnosis, Differential
- Esophagitis/diagnosis
- Esophagitis/drug therapy
- Esophagitis/pathology
- Esophagoscopy
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Mucous Membrane/drug effects
- Mucous Membrane/pathology
- Paraneoplastic Syndromes/diagnosis
- Paraneoplastic Syndromes/drug therapy
- Paraneoplastic Syndromes/pathology
- Pemphigus/diagnosis
- Pemphigus/drug therapy
- Pemphigus/pathology
- Rituximab
- Sjogren's Syndrome/diagnosis
- Sjogren's Syndrome/drug therapy
- Sjogren's Syndrome/pathology
- Ulcer/diagnosis
- Ulcer/drug therapy
- Ulcer/pathology
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Affiliation(s)
- N K Patel
- Department of Gastroenterology, St. Thomas' Hospital, Guy's and St. Thomas' NHS Trust, London, United Kingdom
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Madamwar D, Patel JS, Patel HR, Patel NK. Preparation, characterization and antimicrobial activity of acrylate copolymer bound amoxycillin. Indian J Pharm Sci 2007. [DOI: 10.4103/0250-474x.39434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Timms MS, Bruce IA, Patel NK. Radiofrequency ablation (coblation): a promising new technique for laryngeal papillomata. J Laryngol Otol 2006; 121:28-30. [PMID: 17040601 DOI: 10.1017/s0022215106003069] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2006] [Indexed: 11/06/2022]
Abstract
This paper describes a new application for radiofrequency ablation in head and neck surgery. Two patients with extensive laryngeal papillomata were successfully treated using this technology. The technique is described in detail, highlighting the main benefits of this approach as compared with existing techniques. These advantages include limited damage to underlying tissues and a bloodless field.
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Affiliation(s)
- M S Timms
- Department of Otolaryngology, Blackburn Royal Infirmary, Blackburn, UK.
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Athanasiou TC, Patel NK, Renowden SA, Coakham HB. Some patients with multiple sclerosis have neurovascular compression causing their trigeminal neuralgia and can be treated effectively with MVD: report of five cases. Br J Neurosurg 2006; 19:463-8. [PMID: 16574557 DOI: 10.1080/02688690500495067] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The role of trigeminal ganglion percutaneous injection and radio-frequency lesioning procedures for the treatment of trigeminal neuralgia (TGN) in multiple sclerosis (MS) is well established. There is general acceptance that microvascular decompression (MVD) cannot be an appropriate treatment due to the view that the underlying aetiology is a demyelinating plaque affecting the root entry zone of the trigeminal pathway. Recently, MR-imaging has been used in the preoperative investigation of this group of patients demonstrating that neurovascular compression can occasionally be the responsible mechanism and that MVD can be the treatment of choice. We present five cases with MS and TGN. All the patients had failed to respond to medical treatment or percutaneous procedures. Magnetic resonance imaging demonstrated evidence of neurovascular compression in four cases. All the patients underwent MVD. Postoperatively four of the five patients made an uncomplicated recovery, were pain-free and fully satisfied with the result (mean follow-up 38.75 months; range 8-59 months). One patient developed recurrent pain 1 week following surgery and went on to have a total sensory rhizotomy. TGN in MS can be caused by neurovascular compression, which may be identified on MR-imaging. MVD has offered satisfactory short-term outcome for at least 2 years and does not inflict sensory loss. Longer follow-up will determine whether the outcome in MS patients will be as successful as in the TGN patients who do not suffer from MS.
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Affiliation(s)
- T C Athanasiou
- Department of Neurosurgery, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, UK
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Khairuzzaman A, Ahmed SU, Savva M, Patel NK. Zero-order release of aspirin, theophylline and atenolol in water from novel methylcellulose glutarate matrix tablets. Int J Pharm 2006; 318:15-21. [PMID: 16621361 DOI: 10.1016/j.ijpharm.2006.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2005] [Revised: 02/28/2006] [Accepted: 03/10/2006] [Indexed: 11/29/2022]
Abstract
A novel hydrocolloidal polymer, methylcellulose glutarate (MC-GA), was prepared by esterifying methylcellulose with glutaric anhydride. The formation of ester was confirmed by FTIR and NMR spectroscopy, DSC and elemental analysis. The physicochemical properties such as, rate of swelling in water, viscosity and hygroscopicity of MC-GA were determined and compared with those of methycellulose A (MC). Aspirin, theophylline and atenolol tablets were compacted on a Carver press using the wet granulation method. Each tablet contained: 200 mg active, 80 mg anhydrous lactose, 8 mg povidone, 4 mg magnesium stearate, 4 mg talc, 50mg MC or MC-GA (drug-to-polymer ratio, 4:1). Contrary to the first-order release profile of all the drugs from the MC matrix tablets, a zero-order release was obtained from the MC-GA matrix tablets in water.
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Affiliation(s)
- A Khairuzzaman
- Division of Pharmaceutical Sciences, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, University Plaza, Brooklyn, NY 11201, USA
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Wong AM, Patel NV, Patel NK, Wei M, Morgan TE, de Beer MC, de Villiers WJS, Finch CE. Macrosialin increases during normal brain aging are attenuated by caloric restriction. Neurosci Lett 2005; 390:76-80. [PMID: 16157452 DOI: 10.1016/j.neulet.2005.07.058] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [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: 05/17/2005] [Revised: 07/13/2005] [Accepted: 07/30/2005] [Indexed: 10/25/2022]
Abstract
During normal aging, microglia develop an activated phenotype characterized by morphologic changes and induction of CD11b, MHC II, and other inflammatory markers. We show that macrosialin (CD68), a macrophage-specific protein, is increased by aging in selected brain regions of male C57BL/6NNia mice. In corpus callosum and striatum, macrosialin mRNA and protein increased >or=50% (24 months versus 4 months); hippocampus and cerebellum were unchanged. Caloric restriction (CR) attenuated these age-related increases. Since CR attenuates age-related increases in oxidative damage and inflammation, we examined whether oxidized lipoproteins and inflammatory processes regulate macrosialin using murine BV-2 microglial cells as a model. Oxidized low-density lipoproteins (oxLDL) induced macrosialin protein by 50%. Moreover, macrosialin was induced in response to lipopolysaccharide (LPS) plus interferon-gamma (IFN-gamma) which activates inflammatory pathways in BV-2 cells. Thus, the previously documented increase in oxidized lipoproteins, inflammation, and microglial activation during normal aging may contribute to the age-related increase in macrosialin expression.
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Affiliation(s)
- Angela M Wong
- Andrus Gerontology Center and Department of Biological Sciences, University of Southern California, Los Angeles, CA 90089-0191, USA.
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Sarin A, Nagpal J, Bohra NK, Jiloha RC, Rao GP, Sharma SK, Vaishnav M, Vaya L, Karan RS, Patel NK, Patel R. Open labeled, randomized, switch-over study of two fixed doses (10/15mg) of aripiprazole : to evaluate its safety and efficacy in the treatment of Indian patients of schizophrenia. Indian J Psychiatry 2004; 46:64-71. [PMID: 21206777 PMCID: PMC2912679] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Aripiprazole is a new anti psychotic with a unique receptor binding profile that combines partial agonistic activity at D2 receptor and 5-HT 1A receptor and potent antagonism at 5-HT 2A receptor. This receptor profile makes it possible for it to act as a dopamine system stabilizer. Based on various short term and long term studies, aripiprazole has been found to be effective in schizophrenia and has no significant adverse effect on QTc prolongation, prolactin, serum lipids, and has a low potential for weight gain. Present study aims to evaluate the efficacy and tolerability of aripiprazole (10-15mg/day) in the treatment of Indian patients of schizophrenia and to see its effect on QTc interval, prolactin levels, serum lipids, plasma sugar and weight gain in these patients. Outpatients with an ongoing/newly diagnosed ICD-10 Schizophrenia (n=136) were randomly assigned to 10 or 15 mg dose of Aripiprazole for a period of six weeks. Clinical response was evaluated by the Positive And Negative Symptoms Scale (PANSS), Clinical Global Impression (CGI) scale and safety was evaluated by observing spontaneously reported adverse events and changes in various laboratory parameters. Switching schizophrenic patients to aripiprazole (10/15 mg) from both conventional and atypical anti-psychotics was safe and well tolerated. Six weeks after switching to aripiprazole, patients showed improvements in PANSS scores (P< 0.001), EPS, prolactin levels and weight over the baseline levels. No difference was seen in the 10 or 15mg dose groups. One hospitalization was reported (due to hepatitis E). Common side effects reported were insomnia, somnolence, nausea, vomiting and diarrhea. Aripiprazole is a safe and effective anti psychotic in Indian patients - both in newly diagnosed, as well as, in patients not responding to or intolerant to other available typical and atypical antipsychotics.
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Affiliation(s)
- A Sarin
- Consultant Psychiatrist, Vidyasagar Institute of Mental Health and Neurosciences, 1, Institutional Area, Nehrunagar, New Delhi - 110 017
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Patel NK, Plaha P, O'Sullivan K, McCarter R, Heywood P, Gill SS. MRI directed bilateral stimulation of the subthalamic nucleus in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 2003; 74:1631-7. [PMID: 14638880 PMCID: PMC1757425 DOI: 10.1136/jnnp.74.12.1631] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Bilateral chronic high frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) has emerged as an appropriate therapy for patients with advanced Parkinson's disease refractory to medical therapy. Advances in neuroimaging and neurophysiology have led to the development of varied targeting methods for the delivery of this treatment. Intraoperative neurophysiological and clinical monitoring is regarded by many to be mandatory for accurate STN localisation. We have examined efficacy of bilateral STN stimulation using a predominantly magnetic resonance imaging (MRI)-directed technique. METHODS DBS leads were stereotactically implanted into the STN using an MRI directed method, with intraoperative macrostimulation used purely for adjustment. The effects of DBS were evaluated in 16 patients followed up to 12 months, and compared with baseline assessments. Assessments were performed in both off and on medication states, and were based on the Unified Parkinson's Disease Rating Scale (UPDRS) and timed motor tests. Functional status outcomes were examined using the PDQ-39 quality of life questionnaire. A battery of psychometric tests was used to assess cognition. RESULTS After 12 months, stimulation in the off medication state resulted in significant improvements in Activities of Daily Living and Motor scores (UPDRS parts II and III) by 62% and 61% respectively. Timed motor tests were significantly improved in the off medication state. Motor scores (UPDRS part III) were significantly improved by 40% in the on medication state. Dyskinesias and off duration were significantly reduced and the mean dose of L-dopa equivalents was reduced by half. Psychometric test scores were mostly unchanged or improved. Adverse events were few. CONCLUSIONS An MRI directed targeting method for implantation of DBS leads into the STN can be used safely and effectively, and results are comparable with studies using intraoperative microelectrode neurophysiological targeting. In addition, our method was associated with an efficient use of operating time, and without the necessary costs of microelectrode recording.
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Affiliation(s)
- N K Patel
- Institute of Neurosciences, Frenchay Hospital, Bristol, UK
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