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Baxter MA, Denholm M, Kingdon SJ, Kathirgamakarthigeyan S, Parikh S, Shakir R, Johnson R, Martin H, Walton M, Yao W, Swan A, Samuelson C, Ren X, Cooper A, Gray HL, Clifton S, Ball J, Gullick G, Anderson M, Dodd L, Hayhurst H, Salama M, Shotton R, Britton F, Christodoulou T, Abdul-Hamid A, Eichholz A, Evans RM, Wallroth P, Gibson F, Poole K, Rowe M, Harris J. CAnceR IN PreGnancy (CARING) - a retrospective study of cancer diagnosed during pregnancy in the United Kingdom. Br J Cancer 2024; 130:1261-1268. [PMID: 38383704 PMCID: PMC11014900 DOI: 10.1038/s41416-024-02605-x] [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: 11/24/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population. METHODS In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020). RESULTS Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%. CONCLUSIONS This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.
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Affiliation(s)
- M A Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK.
| | - M Denholm
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
| | - S J Kingdon
- Exeter Oncology Centre, Royal Devon University Hospitals NHS Trust, Exeter, UK
| | | | - S Parikh
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Shakir
- Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Johnson
- Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Martin
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, Cambridge University, Cambridge, UK
| | - M Walton
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - W Yao
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - C Samuelson
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - X Ren
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - A Cooper
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - H-L Gray
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - S Clifton
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - J Ball
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - G Gullick
- Oncology Department, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - M Anderson
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - L Dodd
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - H Hayhurst
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - M Salama
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Shotton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - F Britton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - T Christodoulou
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A Abdul-Hamid
- Department of Oncology, Royal Surrey County Hospital NHS Trust, Surrey, UK
| | - A Eichholz
- Department of Oncology, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - R M Evans
- South West Wales Cancer Centre, Swansea Bay NHS Trust, Swansea, UK
| | | | - F Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Poole
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, Belmont, Sutton, Surrey, UK
| | - M Rowe
- Sunrise Oncology Centre, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - J Harris
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Orellana KJ, Houlihan NV, Carter MV, Baghdadi S, Baldwin K, Stevens AC, Cruz AI, Ellis HB, Green DW, Kushare I, Johnson B, Kerrigan A, Kirby JC, MacDonald JP, McKay SD, Milbrandt TA, Justin Mistovich R, Parikh S, Patel N, Schmale G, Traver JL, Yen YM, Ganley TJ. Tibial Spine Fractures in the Child and Adolescent Athlete: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:1357-1366. [PMID: 37326248 DOI: 10.1177/03635465231175674] [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] [Indexed: 06/17/2023]
Abstract
BACKGROUND Tibial spine fractures (TSFs) are uncommon injuries that may result in substantial morbidity in children. A variety of open and arthroscopic techniques are used to treat these fractures, but no single standardized operative method has been identified. PURPOSE To systematically review the literature on pediatric TSFs to determine the current treatment approaches, outcomes, and complications. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A systematic review of the literature was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines using PubMed, Embase, and Cochrane databases. Studies evaluating treatment and outcomes of patients <18 years old were included. Patient demographic characteristics, fracture characteristics, treatments, and outcomes were abstracted. Descriptive statistics were used to summarize categorical and quantitative variables, and a meta-analytic technique was used to compare observational studies with sufficient data. RESULTS A total of 47 studies were included, totaling 1922 TSFs in patients (66.4% male) with a mean age of 12 years (range, 3-18 years). The operative approach was open reduction and internal fixation in 291 cases and arthroscopic reduction and internal fixation in 1236 cases; screw fixation was used in 411 cases and suture fixation, in 586 cases. A total of 13 nonunions were reported, occurring most frequently in Meyers and McKeever type III fractures (n = 6) and in fractures that were treated nonoperatively (n = 10). Arthrofibrosis rates were reported in 33 studies (n = 1700), and arthrofibrosis was present in 190 patients (11.2%). Range of motion loss occurred significantly more frequently in patients with type III and IV fractures (P < .001), and secondary anterior cruciate ligament (ACL) injury occurred most frequently in patients with type I and II fractures (P = .008). No statistically significant differences were found with regard to rates of nonunion, arthrofibrosis, range of motion loss, laxity, or secondary ACL injury between fixation methods (screw vs suture). CONCLUSION Despite variation in TSF treatment, good overall outcomes have been reported with low complication rates in both open and arthroscopic treatment and with both screw and suture fixation. Arthrofibrosis remains a concern after surgical treatment for TSF, but no significant difference in incidence was found between the analysis groups. Larger studies are necessary to compare outcomes and form a consensus on how to treat and manage patients with TSFs.
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Affiliation(s)
- Kevin J Orellana
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nathan V Houlihan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael V Carter
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Soroush Baghdadi
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Keith Baldwin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Aristides I Cruz
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Henry B Ellis
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | | | | | | | | | | | | | | | | | - R Justin Mistovich
- University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Shital Parikh
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Neeraj Patel
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | | | - Jessica L Traver
- Jessica L. Traver, MD (University of Texas Health Houston, Houston, Texas, USA
| | - Yi-Meng Yen
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Parikh S, Jayaprakash KT. OncoFlash-Research Updates in a Flash! (Feb 2024). Clin Oncol (R Coll Radiol) 2024; 36:67-69. [PMID: 38199674 DOI: 10.1016/j.clon.2024.01.001] [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: 01/12/2024]
Affiliation(s)
- S Parikh
- Cancer Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - K Thippu Jayaprakash
- Cancer Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Oncology, The Queen Elizabeth Hospital King's Lynn, King's Lynn, United Kingdom.
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Evans SM, Ivanova K, Rome R, Cossio D, Pilgrim C, Zalcberg J, Antill Y, Blake L, Du Guesclin A, Garrett A, Giffard D, Golobic N, Moir D, Parikh S, Parisi A, Sanday K, Shadbolt C, Smith M, Te Marvelde L, Williams K. Registry-derived stage (RD-Stage) for capturing cancer stage at diagnosis for endometrial cancer. BMC Cancer 2023; 23:1222. [PMID: 38087227 PMCID: PMC10714535 DOI: 10.1186/s12885-023-11615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Capture of cancer stage at diagnosis is important yet poorly reported by health services to population-based cancer registries. In this paper we describe current completeness of stage information for endometrial cancer available in Australian cancer registries; and develop and validate a set of rules to enable cancer registry medical coders to calculate stage using data available to them (registry-derived stage or 'RD-Stage'). METHODOLOGY Rules for deriving RD-stage (Endometrial carcinoma) were developed using the American Joint Commission on Cancer (AJCC) TNM (tumour, nodes, metastasis) Staging System (8th Edition). An expert working group comprising cancer specialists responsible for delivering cancer care, epidemiologists and medical coders reviewed and endorsed the rules. Baseline completeness of data fields required to calculate RD-Stage, and calculation of the proportion of cases for whom an RD stage could be assigned, was assessed across each Australian jurisdiction. RD-Stage (Endometrial cancer) was calculated by Victorian Cancer Registry (VCR) medical coders and compared with clinical stage recorded by the patient's treating clinician and captured in the National Gynae-Oncology Registry (NGOR). RESULTS The necessary data completeness level for calculating RD-Stage (Endometrial carcinoma) across various Australian jurisdictions varied from 0 to 89%. Three jurisdictions captured degree of spread of cancer, rendering RD-Stage unable to be calculated. RD-Stage (Endometrial carcinoma) could not be derived for 64/485 (13%) cases and was not captured for 44/485 (9%) cases in NGOR. At stage category level (I, II, III, IV), there was concordance between RD-Stage and NGOR captured stage in 393/410 (96%) of cases (95.8%, Kendall's coefficient = 0.95). CONCLUSION A lack of consistency in data captured by, and data sources reporting to, population-based cancer registries meant that it was not possible to provide national endometrial carcinoma stage data at diagnosis. In a sample of Victorian cases, where surgical pathology was available, there was very good concordance between RD-Stage (Endometrial carcinoma) and clinician-recorded stage data available from NGOR. RD-Stage offers promise in capturing endometrial cancer stage at diagnosis for population epidemiological purposes when it is not provided by health services, but requires more extensive validation.
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Affiliation(s)
- S M Evans
- Cancer Council Victoria, Melbourne, Australia.
| | - K Ivanova
- Cancer Council Victoria, Melbourne, Australia
| | - R Rome
- Epworth Health Care, Melbourne, Australia
| | - D Cossio
- Cancer Alliance Queensland, Woolloongabba, Australia
| | - Chc Pilgrim
- Central Clinical School, Department of Surgery, The Alfred, Monash University, Melbourne, Australia
| | - J Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Y Antill
- Monash University, Melbourne, Australia
| | - L Blake
- Cancer Council Victoria, Melbourne, Australia
| | - A Du Guesclin
- Department of Anatomical Pathology, The Alfred, Melbourne, Australia
| | - A Garrett
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - D Giffard
- Cancer Alliance Queensland, Woolloongabba, Australia
| | - N Golobic
- Cancer Alliance Queensland, Woolloongabba, Australia
| | - D Moir
- Department of Anatomical Pathology, The Alfred, Melbourne, Australia
| | - S Parikh
- Cancer Council Victoria, Melbourne, Australia
| | - A Parisi
- ACT Cancer Registry Australian Capital Territory Health, Deakin, Australia
| | - K Sanday
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - C Shadbolt
- Royal Women's Hospital, Melbourne, Australia
| | - M Smith
- ACT Cancer Registry Australian Capital Territory Health, Deakin, Australia
| | | | - K Williams
- Cancer Council Victoria, Melbourne, Australia
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Parikh S, Lindquester W, Dhangana R. Abstract No. 520 National Trends of Cholecystostomy Tube Placement and Cholecystectomy from 2000 to 2018. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Rohde MS, Shea KG, Dawson T, Heyworth BE, Milewski MD, Edmonds EW, Adsit E, Wilson PL, Albright J, Algan S, Beck J, Bowen R, Brey J, Cardelia M, Clark C, Crepeau A, Edmonds EW, Ellington M, Ellis HB, Fabricant P, Frank J, Ganley T, Green D, Gupta A, Heyworth BE, Latz K, Mansour A, Mayer S, McKay S, Milewski M, Niu E, Pacicca D, Parikh S, Rhodes J, Saper M, Schmale G, Schmitz M, Shea K, Storer S, Wilson PL, Ellis HB. Age, Sex, and BMI Differences Related to Repairable Meniscal Tears in Pediatric and Adolescent Patients. Am J Sports Med 2023; 51:389-397. [PMID: 36629442 DOI: 10.1177/03635465221145939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND The incidence of meniscus tears and ACL tears in pediatric patients continues to rise, bringing to question the risk factors associated with these injuries. As meniscus tears are commonly repaired in pediatric populations, the epidemiology of repairable meniscus tears is an important for consideration for surgeons evaluating treatment options. PURPOSE To describe meniscal tear patterns in pediatric and adolescent patients who underwent meniscal repair across multiple institutions and surgeons, as well as to evaluate the relationship between age, sex, and body mass index (BMI) and their effect on the prevalence, type, and displacement of repaired pediatric meniscal tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS Data within a prospective multicenter cohort registry for quality improvement, Sport Cohort Outcome Registry (SCORE), were reviewed to describe repaired meniscal tear patterns. All consecutive arthroscopic meniscal repairs from participating surgeons in patients aged <19 years were analyzed. Tear pattern, location, and displacement were evaluated by patient age, sex, and BMI. A subanalysis was also performed to investigate whether meniscal tear patterns differed between those occurring in isolation or those occurring with a concomitant anterior cruciate ligament (ACL) injury. Analysis of variance was used to generate a multivariate analysis of specified variables. Sex, age, and BMI results were compared across the cohort. RESULTS There were 1185 total meniscal repairs evaluated in as many patients, which included 656 (55.4%) male and 529 (44.6%) female patients. Patients underwent surgery at a mean age of 15.3 years (range, 5-19 years), with a mean BMI of 24.9 (range, 12.3-46.42). Of the 1185 patients, 816 (68.9%) had ACL + meniscal repair and 369 (31.1%) had isolated meniscal repair. The male patients underwent more lateral tear repairs than the female patients (54.3% to 40.9%; P < .001) and had a lower incidence of medial tear repair (32.1% vs 41.4%; P < .001). Patients with repaired lateral tears had a mean age of 15.0 years, compared with a mean age of 15.4 years for patients with repaired medial or bilateral tears (P = .001). Higher BMI was associated with "complex" and "radial" tear repairs of the lateral meniscus (P < .001) but was variable with regard to medial tear repairs. CONCLUSION In pediatric and adolescent populations, the data suggest that the surgical team treating knees with potential meniscal injury should be prepared to encounter more complex meniscal tears, commonly indicated in those with higher BMI, while higher rates of lateral meniscal tears were seen in male and younger patients. Future studies should analyze correlates for meniscal repair survival and outcomes in this pediatric cohort undergoing knee surgery.
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Affiliation(s)
- Matthew S Rohde
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Kevin G Shea
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Timothy Dawson
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Benton E Heyworth
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Matthew D Milewski
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Eric W Edmonds
- Rady Children's Hospital, Division of Orthopaedic Surgery, San Diego, California, USA
| | | | - Philip L Wilson
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA
| | | | - Jay Albright
- Children's Hospital Colorado, Department of Orthopedics, Aurora, Colorado, USA
| | - Sheila Algan
- Oklahoma Children's Hospital, Department of Orthopedic Surgery, Oklahoma City, Oklahoma, USA
| | - Jennifer Beck
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA; Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Richard Bowen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA; Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Jennifer Brey
- Norton Children's Orthopedics of Louisville, Department of Orthopedics, Louisville, Kentucky, USA
| | - Marc Cardelia
- Children's Hospital of the King's Daughters, Department of Orthopedics and Sports Medicine, Norfolk, Virginia, USA
| | - Christian Clark
- OrthoCarolina Pediatric Orthopaedic Center, Charlotte, North Carolina, USA
| | - Allison Crepeau
- Elite Sports Medicine at Connecticut Children's, Hartford, Connecticut, USA; UConn Health, Division of Sports Medicine, Department of Orthopedics, Farmington, Connecticut, USA
| | - Eric W Edmonds
- Rady Children's Hospital, Division of Orthopaedic Surgery, San Diego, California, USA
| | - Matt Ellington
- Central Texas Pediatric Orthopedics, Department of Orthopedics, Austin, Texas, USA; Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Henry B Ellis
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA
| | - Peter Fabricant
- Hospital for Special Surgery, Division of Pediatric Orthopaedic Surgery, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
| | - Jeremy Frank
- Joe DiMaggio Children's Hospital, Division of Pediatric Orthopaedics and Spinal Deformities, Hollywood, Florida, USA
| | - Ted Ganley
- Children's Hospital of Philadelphia, Sports Medicine and Performance Center, Philadelphia, Pennsylvania, USA
| | - Dan Green
- Hospital for Special Surgery, Division of Pediatric Orthopaedic Surgery, New York, New York, USA
| | - Andrew Gupta
- Joe DiMaggio Children's Hospital, Division of Pediatric Orthopaedics and Spinal Deformities, Hollywood, Florida, USA
| | - Benton E Heyworth
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Kevin Latz
- Children's Mercy, Department of Orthopedics-Sports Medicine, Kansas City, Missouri, USA
| | - Alfred Mansour
- UTHealth Houston, McGovern Medical School, Department of Orthopedic Surgery, Houston, Texas, USA
| | - Stephanie Mayer
- Children's Hospital of Colorado, Department of Orthopaedic Surgery, Denver, Colorado, USA
| | - Scott McKay
- Texas Children's Hospital, Department of Orthopedic Surgery, Houston, Texas, USA
| | - Matt Milewski
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Emily Niu
- Children's National Medical Center, Department of Orthopedic Surgery and Sports Medicine, Washington, DC, USA
| | - Donna Pacicca
- Children's Mercy, Department of Orthopedics-Sports Medicine, Kansas City, Missouri, USA
| | - Shital Parikh
- Cincinnati Children's Hospital Medical Center, Division of Orthopaedic Surgery, Cincinnati, Ohio, USA
| | - Jason Rhodes
- Children's Hospital Colorado, Department of Orthopedics, Aurora, Colorado, USA
| | - Michael Saper
- Seattle Children's Hospital, Department of Orthopedics and Sports Medicine, Seattle, Washington, USA
| | - Greg Schmale
- Seattle Children's Hospital, Department of Orthopedics and Sports Medicine, Seattle, Washington, USA
| | - Matthew Schmitz
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Kevin Shea
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Stephen Storer
- Joe DiMaggio Children's Hospital, Division of Pediatric Orthopaedics and Spinal Deformities, Hollywood, Florida, USA
| | - Philip L Wilson
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA
| | - Henry B Ellis
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA.,Investigation performed at Scottish Rite for Children, University of Texas Southwestern, Dallas, Texas, USA
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Kim HK, Parikh S. Patellofemoral Instability in Children: Imaging Findings and Therapeutic Approaches. Korean J Radiol 2022; 23:674-687. [PMID: 35555883 PMCID: PMC9174504 DOI: 10.3348/kjr.2021.0577] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/08/2022] [Accepted: 02/19/2022] [Indexed: 11/15/2022] Open
Abstract
Patellofemoral instability (PFI) is common in pediatric knee injuries. PFI results from loss of balance in the dynamic relationship of the patella in the femoral trochlear groove. Patellar lateral dislocation, which is at the extreme of the PFI, results from medial stabilizer injury and leads to the patella hitting the lateral femoral condyle. Multiple contributing factors to PFI have been described, including anatomical variants and altered biomechanics. Femoral condyle dysplasia is a major risk factor for PFI. Medial stabilizer injury contributes to PFI by creating an imbalance in dynamic vectors of the patella. Increased Q angle, femoral anteversion, and lateral insertion of the patellar tendon are additional contributing factors that affect dynamic vectors on the patella. An imbalance in the dynamics results in patellofemoral malalignment, which can be recognized by the presence of patella alta, patellar lateral tilt, and lateral subluxation. Dynamic cross-sectional images are useful for in vivo tracking of the patella in patients with PFI. Therapeutic approaches aim to restore normal patellofemoral dynamics and prevent persistent PFI. In this article, the imaging findings of PFI, including risk factors and characteristic findings of acute lateral patellar dislocation, are reviewed. Non-surgical and surgical approaches to PFI in pediatric patients are discussed.
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Affiliation(s)
- Hee Kyung Kim
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
| | - Shital Parikh
- Devision of Pediatric Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Roman CM, Cox M, Sakemura R, Yun K, Adada M, Siegler E, Sirpilla O, Tapper E, Stewart C, Ogbodo E, Can I, Schick K, Bezerra E, Fonkoua LK, Hefazi M, Ruff M, Ding W, Parikh S, Slager S, Kay N, Olivier G, Scholler N, Bot A, Mattie M, Kim J, Filosto S, Kenderian S. Immunotherapy: TNFR2 AS A TARGET TO IMPROVE CD19-DIRECTED CART CELL FITNESS AND ANTITUMOR ACTIVITY IN LARGE B CELL LYMPHOMA. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Yadav R, Parikh S, Panchal H, Patel A, Garg A, Shah K, Basu P, Patel V, Ganta S, Ravichandran S, Banerjee D. 34P Efficacy and toxicity analysis of imatinib in newly diagnosed patients of chronic myeloid leukaemia: 18-years’ experience at a single large-volume centre. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Easwaran R, Khan M, Sancheti P, Shyam A, Bhandari M, Ranawat AS, Thakkar S, Parikh S, Musahl V, Joglekar S, J Deshmukh A, Plancher K, Verma N, McAllister D, Verdonk P, Lustig S, Chandrateya A, Smigleiski R, Solayar G, Chernchujit B, Yung P, Budhiparama N, Hoshino Y, White N, Parker D, Clatworthy M, Brown C, Manzary M, Rajan D, Narvekar A, Tapasvi S, Pardiwala D, Panigrahi R, Arumugam S, Kapoor V, Mody B, Maheshwari J, Dahiya V, Joseph C, Laddha M, Rajgopal A. Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts. Knee Surg Sports Traumatol Arthrosc 2022; 30:3634-3643. [PMID: 35435469 PMCID: PMC9013735 DOI: 10.1007/s00167-022-06973-w] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a lack of consensus regarding need for Venous Thrombo Embolism (VTE) prophylaxis following arthroscopic knee surgery and open soft tissue knee reconstruction. Clear cut guidelines like ones for trauma surgery and arthroplasty do not exist and the published literature is limited to case reports with a few society guidelines. Given this lack of consensus, we conducted a modified Delphi questionnaire of international experts to provide recommendations on this topic. METHODS The consensus statements were generated using an anonymised 3 round modified Delphi questionnaire, sent to an international panel of 38 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics with measures like mode, median and box plots. Feedback was provided to all panelists based on responses from the previous rounds to help generate the consensus. RESULTS Six consensus statements were generated after the three rounds of Delphi. Patient factors, prolonged surgery duration and family history of thrombogenic events emerged as the main points to be taken into consideration for prophylaxis. CONCLUSION It was established through this study, that there exists a select group of patients undergoing arthroscopic surgery that justify the usage of VTE prophylaxis. The expert responses to most of the questions in different scenarios favoured usage of VTE prophylaxis based on patient factors like advanced age, past history of VTE, smoking, oral contraceptive use etc. LEVEL OF EVIDENCE: Level V.
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Affiliation(s)
- Raju Easwaran
- Shree Meenakshi Orthopedics and Sports Medicine Clinic, B H 41 East, Shalimar Bagh, New Delhi, 110088, India.
- Department of Arthroscopy and Sports Injuries, Max Super-Speciality Hospital Shalimar Bagh, New Delhi, India.
| | - Moin Khan
- Sports Medicine and Shoulder Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation and PG College, Pune, India
| | - Ashok Shyam
- Sancheti Institute for Orthopedics and Rehabilitation, Pune, India
| | - Mohit Bhandari
- Chair, Department of Surgery, McMaster University, Hamilton, Canada
| | - Anil S Ranawat
- Knee Division of SMI, Hospital for Special Surgery, New York, USA
| | - Savyasachi Thakkar
- Johns Hopkins Orthopaedics, Hip and Knee Reconstruction Surgery, Columbia, USA
| | - Shital Parikh
- Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Siddharth Joglekar
- Orthopedic Service, VA Central California Health Care System, Fresno, CA, USA
- UCSF Fresno Orthopedic Residency Program, Fresno, USA
| | | | - Kevin Plancher
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
- Weill Cornell Medical College, New York, USA
- Orthopaedic Foundation, Stamford, CT, USA
- Plancher Orthopaedics and Sports Medicine, New York, USA
| | - Nikhil Verma
- Division of Sports Medicine, Sports Medicine Fellowship, Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, USA
| | - David McAllister
- Sports Medicine Service, Vice Chair of Academic Affairs, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
- UCLA Department of Athletics, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Peter Verdonk
- Orthopaedic Center Antwerp, Antwerp, Belgium
- Department of Orthopaedic Surgery, Antwerp University, Antwerp, Belgium
| | - Sebastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, Lyon, France
| | - Amit Chandrateya
- Princess of Wales Hospital Bridgend, Cwm Taf Morgannwg University Health Board, Bridgend, UK
| | - Robert Smigleiski
- Orthopaedics and Sports Medicine, Department at LIFE Institute, LIFE Institute Biological Treatment Centre, Warsaw, Poland
| | - Gandhi Solayar
- Orthopaedic Specialist Centre, Subang Jaya, Selangor, Malaysia
| | - Bancha Chernchujit
- Department of Orthopedics, Thammasat University Hospital, Khlong Nueng, Thailand
| | - Patrick Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong, China
| | - Nicolaas Budhiparama
- School of Vocational Studies and Department of Orthopaedics and Traumatology, School of Medicine, University of Airlangga, Jl. Mayjend. Prof. Dr. Moestopo, Jawa Timur, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakarta, Indonesia
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, School of Medicine, Kobe University, Kobe, Japan
| | | | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, Australia
| | | | - Charlie Brown
- International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| | - Mojieb Manzary
- Orthopedic Services, Johns Hopkins Aramco Health Care Center, Dhahran, Saudi Arabia
- Department of Orthopedics, Johns Hopkins University School of Medicine, Dhahran, Saudi Arabia
| | - David Rajan
- Ortho One-Orthopaedic Speciality Centre, Coimbatore, India
| | - Abhay Narvekar
- P D Hinduja Hospitals Mumbai, Global Hospital Parel, Mumbai, India
| | | | - Dinshaw Pardiwala
- Arthroscopy Service, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Ranjit Panigrahi
- PG Dept of Orthopaedics, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India
- Kalinga Super Speciality Hospital, Bhubaneswar, Odisha, India
| | - S Arumugam
- Centre for Sports Science, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Chennai, India
| | - Vikash Kapoor
- Medica Superspeciality Hospital, Medica Hospitals, Kolkata, India
| | - Bharat Mody
- Welcare Hospital, Atladra-Vadsar Ring Road, Atladra, Vadodara, Gujarat, India
| | - Jitender Maheshwari
- Knee and Shoulder Service, Department of Orthopaedics, Sitaram Bharatiya Hospital, New Delhi, India
| | - Vivek Dahiya
- Adult Reconstruction Lower Limb, Institute of Musculoskeletal Disorders and Orthopaedics, Medanta, Gurugram, India
| | - Clement Joseph
- Arthroscopy and Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, India
| | | | - Ashok Rajgopal
- Institute of Musculoskeletal Diseases and Orthopaedics, Medanta Medicity, Gurugram, Haryana, India
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Parikh S, Smick A, Bird L, Patel N. Treatment Failure Rates of Second-Generation Endometrial Ablation Devices in Premenopausal Women with BMI≥35 Kg/m2. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parikh A, Parikh S. Snapshots Quiz. Br J Surg 2021; 108:1180. [PMID: 34308468 DOI: 10.1093/bjs/znab236] [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] [Received: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022]
Affiliation(s)
- A Parikh
- Department of Gastroenterology, Lilavati Hospital and Research Centre, Bandra (West), Mumbai, India
| | - S Parikh
- Department of Gastroenterology, Lilavati Hospital and Research Centre, Bandra (West), Mumbai, India
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Parikh S, Cooper L, Matthews W, Khan M, Syed S, Vasudevan SP, Brosnan C, Barr L, Loeffler M. Safety of emergency, elective and day case operating during the winter period at East Suffolk and North Essex NHS Foundation Trust: lessons from the outcomes of 4,254 surgical patients from the first COVID-19 wave. Ann R Coll Surg Engl 2021; 103:478-480. [PMID: 34192500 DOI: 10.1308/rcsann.2021.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period. METHODS We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission. RESULTS There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery. CONCLUSIONS There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.
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Affiliation(s)
- S Parikh
- East Suffolk and North Essex NHS Foundation Trust, UK
| | - L Cooper
- East Suffolk and North Essex NHS Foundation Trust, UK
| | - W Matthews
- East Suffolk and North Essex NHS Foundation Trust, UK
| | - M Khan
- East Suffolk and North Essex NHS Foundation Trust, UK
| | - S Syed
- East Suffolk and North Essex NHS Foundation Trust, UK
| | - S P Vasudevan
- East Suffolk and North Essex NHS Foundation Trust, UK
| | - C Brosnan
- East Suffolk and North Essex NHS Foundation Trust, UK
| | - L Barr
- East Suffolk and North Essex NHS Foundation Trust, UK
| | - M Loeffler
- East Suffolk and North Essex NHS Foundation Trust, UK
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Furie R, Parikh S, Wang J, Bomba D, Leff R, Kirk C, Henig N. POS0695 KZR-616, A SELECTIVE IMMUNOPROTEASOME INHIBITOR FOR THE TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS FROM THE COMPLETED DOSE ESCALATION PHASE 1B PORTION OF THE MISSION STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:KZR-616 is a first-in-class selective inhibitor of the immunoproteasome, which is active in >15 autoimmune disease models, including murine models of systemic lupus erythematosus (SLE)/lupus nephritis (LN).1,2,3 Selective inhibition of the immunoproteasome modulates both innate and adaptive immune effector cells, resulting in reduced inflammatory T helper cell subsets (Th1 and Th17), increased regulatory T cells, and decreased plasma cells and autoantibodies. KZR-616 was well tolerated in two healthy volunteer studies of 100 subjects receiving up to 75 mg subcutaneously (SC). Target levels of immunoproteasome inhibition were observed at doses ≥30 mg.3,4 KZR-616 is currently in Phase 2 studies for several autoimmune indications, including the ongoing Phase 2 portion of the MISSION Study (KZR-616-002; NCT0339013) in patients with LN.Objectives:Results of the completed MISSION Phase 1b dose escalation portion of the study are reported.Methods:In the open-label, multicenter, dose escalation Phase 1b portion, SLE patients (per SLICC Classification Criteria) with SLEDAI ≥4 despite stable background immunosuppressant, anti-malarial, and/or corticosteroid therapy were administered weekly KZR-616 subcutaneously at doses of 45 mg (cohort 1), 60 mg (cohort 2), 60 mg following step-up doses of 30 mg and 45 mg (cohort 2a), 60 mg following a step-up dose of 30 mg (cohorts 2b, 2c) or 75 mg following a step-up dose of 30 mg (cohort 3) for 13 weeks with follow-up through Week 25 (W25); a lyophilized formulation was used for cohorts 2b, 2c and 3. The disease activity measures assessed were: SLEDAI-2K, Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), 28 tender and swollen joint counts, Physician and Patient Global Assessments, and Patient Assessment of Pain. Safety and tolerability were assessed in the safety population (patients receiving at least one dose of KZR-616).Results:The Phase 1b portion of MISSION enrolled 47 SLE patients, including 2 patients with active proliferative LN. The most common treatment-emergent adverse events (TEAE) were injection site reactions, which were mostly mild. Infections occurred at a low rate, and there were no reports of peripheral neuropathy, prolonged hematologic AEs, or clinically significant laboratory abnormalities. No discontinuations were observed in cohorts 2b and 2c; no serious AEs were reported in cohort 3 and TEAEs were consistent with those reported in earlier cohorts. Mean values of all measures of disease activity improved in evaluable patients who completed the 13-week treatment period, and improvements were generally maintained at W25. All patients with elevated anti-double-stranded DNA antibody (anti-dsDNA) levels at baseline (n=7) had a reduction in levels with 3 of 7 experiencing a >50% reduction in their levels. Two of two patients with active proliferative LN had a >50% reduction in UPCR and experienced reductions in SLEDAI-2K scores as well as anti-dsDNA levels. Exposure to KZR-616, similar to that reported in healthy volunteers, was dose-proportional across doses, and no accumulation was observed.Conclusion:KZR-616 SC, once weekly for 13 weeks up to 75 mg, appears to be safe and well-tolerated in patients with active SLE on stable background therapy in the MISSION Phase 1b. At doses ≥45mg, efficacy was noted, including improvements in proteinuria in two of two patients with LN and serologic improvement in all 7 patients with quantifiable levels of anti-dsDNA antibodies at baseline. KZR-616 60 mg SC weekly for 24 weeks is currently being evaluated in the MISSION Phase 2 in patients with LN. Based on the results of MISSION, inhibition of the immunoproteasome with KZR-616 represents a novel strategy to treat autoimmune diseases.References:[1]Basler M et al. Clin Exp Rheumatol 2015 (suppl 92);S74.[2]Muchamuel T et al. Ann Rheumatol Dis 2018;77(suppl 2);685.[3]Muchamuel T et al. ASN 2020 Virtual Conference.[4]Snyder B et al. ACR/ARP 2019 Annual Meeting.[5]Fan RA et al. ACR/ARP 2019 Annual Meeting.Acknowledgements:Kezar Life Sciences acknowledges the support of site investigators and patient participants in the MISSION studyDisclosure of Interests:Richard Furie Consultant of: Genentech;Kezar Life Sciences, Grant/research support from: Kezar Life Sciences, SV Parikh Consultant of: Aurinia Pharmaceuticals, BMS, GlaxoSmithKline, and Kezar Life Sciences, Grant/research support from: Aurinia Pharmaceuticals;EMD-Serono, Jinhai Wang Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences, Darrin Bomba Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences, Richard Leff Employee of: Kezar Life Sciences [part-time], Christopher Kirk Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences -- full-time employee, Noreen Henig Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences
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Saleem S, Parikh S, Parratt T. 481 Improving the Quality of Pelvic Radiographs - Making A Difference One Picture at A Time. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Inadequate pelvic radiographs can lead to missed pathology, necessitate repeat imaging, and subsequently compromise patient safety. The audit conducted aimed to assess and improve the quality of pelvic radiographs at our Trust against local and international guidelines.
Retrospective analysis of pelvic radiographs over a one-month period using PACS at Colchester General Hospital was conducted. All pelvic radiographs were assessed according to International Guidelines (EUR 16250EN). Postoperative radiographs were measured against local guidelines. The results were then presented in the departmental meeting and a re-audit was performed in June 2020.
A total of 190 pelvic radiographs were collected in September 2019. From the 23 postoperative radiographs, 9 did not include distal end of prosthesis. During the re-audit in June 2020 the same number of pelvic images were collected. Data showed that only 2 out of 29 postoperative images did not include the distal end of the prosthesis.
The audit demonstrated need for improvement at our Trust. This was carried out through a presentation in the departmental meeting, highlighting areas that needed improvement. The re-audited results from June 2020 have shown an improvement in the quality of pelvic radiographs and have had direct implications in clinical outcomes.
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Affiliation(s)
- S Saleem
- Colchester General Hospital, Colchester, United Kingdom
| | - S Parikh
- Colchester General Hospital, Colchester, United Kingdom
| | - T Parratt
- Colchester General Hospital, Colchester, United Kingdom
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Saleem S, Parikh S, Parratt T, Loeffler M. 480 Preoperative Templating in Hip Hemiarthroplasty Improves Femoral Offset and Function. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
The use of preoperative templating for hip hemiarthroplasty increases the likelihood of successfully restoring offset. This study sought to identify whether templating improves radiographic and clinical outcomes in this group.
Data belonging to all patients that underwent hip hemiarthroplasty between March 2018 and March 2019 were collected. The patients were grouped based on whether or not their preoperative images were templated. Radiographs were studied retrospectively to calculate preoperative and postoperative offset and LLD for each patient. The clinical outcomes that were measured included the rate of periprosthetic fracture, dislocation and contra-lateral neck of femur fracture for each group. Data was analysed by SPSS.
There were 208 patients of which 72 were templated and 136 not templated. The percentage difference between the preoperative and postoperative offset was lower in the templated group (p < 0.05). There was no significant difference in radiographic LLD between the two groups. There was no significant difference in the clinical outcomes between the two groups.
A significantly closer restoration to the original offset was achieved with preoperative templating, which is likely to improve function in this group. There were no significant differences in the other clinical outcomes between the two groups.
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Affiliation(s)
- S Saleem
- Colchester General Hospital, Colchester, United Kingdom
| | - S Parikh
- Colchester General Hospital, Colchester, United Kingdom
| | - T Parratt
- Colchester General Hospital, Colchester, United Kingdom
| | - M Loeffler
- Colchester General Hospital, Colchester, United Kingdom
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Ramsey S, Parikh S. Rapid microbiological testing of biologics products using atp bioluminescence. Cytotherapy 2021. [DOI: 10.1016/s1465324921006277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cox M, Manriquez Roman C, Sakemura R, Tapper E, Siegler E, Sinha S, Chappell D, Ahmed O, Durrant C, Hefazi M, Schick K, Horvei P, Ruff M, Can I, Adada M, Bezerra E, Kankeu Fonkoua L, Parikh S, Kay N, Kenderian S. GM-CSF disruption in cart cells ameliorates cart cell activation and reduces activation-induced cell death. Cytotherapy 2021. [DOI: 10.1016/s1465324921002917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ling DI, Brady JM, Arendt E, Tompkins M, Agel J, Askenberger M, Balcarek P, Parikh S, Shubin Stein BE. Development of a Multivariable Model Based on Individual Risk Factors for Recurrent Lateral Patellar Dislocation. J Bone Joint Surg Am 2021; 103:586-592. [PMID: 33787553 DOI: 10.2106/jbjs.20.00020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 02/01/2023]
Abstract
BACKGROUND Nonoperative treatment after first-time patellar dislocation is the standard of care. There is evidence that certain patients may be at high risk for recurrent instability. The aim of this study was to develop a multivariable model to guide management of patients based on their individual risk of recurrent dislocation. METHODS A multivariable model was developed using 291 patients from 4 institutions to identify which patients were at higher risk for recurrent patellar dislocation within 2 years. This model was informed by a univariable logistic regression model developed to test factors based on the patient's history, physical examination, and imaging. The discriminatory ability of the model to classify who will or will not have a recurrent dislocation was measured using the area under the receiver operating characteristic curve (AUC). RESULTS Age, a history of a contralateral patellar dislocation, skeletal immaturity, lateral patellar tilt, tibial tubercle-trochlear groove (TT-TG) distance, Insall-Salvati ratio, and trochlear dysplasia were the most important factors for recurrent patellar dislocation. Sex, mechanism of injury, Caton-Deschamps ratio, sulcus angle, inclination angle, and facet ratio were not factors for recurrent dislocation. The overall AUC for the multivariable model was 71% (95% confidence interval [CI]: 64.7% to 76.6%). CONCLUSIONS Optimizing the management of lateral patellar dislocation will improve short-term disability from the dislocation and reduce the long-term risk of patellofemoral arthritis from repeated chondral injury. This multivariable model can identify patients who are at high risk for recurrent dislocation and would be good candidates for early operative treatment. Further validation of this model in a prospective cohort of patients will inform whether it can be used to determine the optimal treatment plan for patients presenting with an initial patellar dislocation. Until validation of the model is done with new patients, it should not be used in clinical practice. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daphne I Ling
- Hospital for Special Surgery, New York, NY.,Weill Cornell Medical College, New York, NY
| | | | | | | | - Julie Agel
- University of Minnesota, Minneapolis, Minnesota
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Parikh S. Lasmiditan for acute treatment of migraine. Drugs Today (Barc) 2021; 57:89-100. [PMID: 33656015 DOI: 10.1358/dot.2021.57.2.3238326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lasmiditan, a selective 5-HT1F receptor agonist, is a harbinger for the novel ditan class of medications for acute migraine treatment. Lasmiditan activates 5-HT1F receptors on presynaptic trigeminal nerve terminals, which impedes the release of calcitonin gene-related peptide (CGRP) from trigeminal nerve endings and thereby suppresses activation of the trigeminovascular system. Notably, lasmiditan does not result in vasoconstriction, making lasmiditan a migraine-specific acute treatment option for those with cardiovascular risk factors. However, lasmiditan does have centrally mediated side effects. This review will discuss the background of lasmiditan development, its preclinical pharmacology, safety, drug interactions and indications for use.
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Affiliation(s)
- S Parikh
- Thomas Jefferson University Hospitals, Wayne, Pennsylvania, USA.
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Naseer M, Patel A, Anand A, Panchal H, Parikh S, Sajjan K, Madabhavi I, Pareek A. 61P Immune check point inhibitors (ICIs) in cancer therapy: An experience from a resource poor and developing country. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Furie R, Parikh S, Maiquez A, Khan A, Moreno O, Soneira M, Kirk C, Bomba D, Harvey K, Farmer MK. AB0373 TREATMENT OF SLE WITH THE IMMUNOPROTEASOME INHIBITOR KZR-616: RESULTS FROM THE FIRST 4 COHORTS OF THE MISSION STUDY, AN OPEN-LABEL PHASE 1B DOSE ESCALATION TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Non-specific proteasome inhibitors, such as bortezomib (BTZ), target the constitutive proteasome and immunoproteasome and are approved treatments for multiple myeloma1. BTZ has also been used to treat systemic lupus erythematosus (SLE) and lupus nephritis (LN); however, treatment emergent adverse events (TEAEs), such as gastrointestinal (GI) effects, hematologic abnormalities, asthenia and peripheral neuropathy, limit its use as a long-term treatment option for chronic autoimmune disease2. KZR-616 is a first-in-class selective immunoproteasome inhibitor and is highly active in murine SLE3. Subcutaneous (SC) administration of KZR-616 (30 and 45 mg weekly [QW]) was demonstrated as safe and well-tolerated, and successfully achieved target levels of immunoproteasome inhibition in healthy volunteers4, 5.Objectives:We report the preliminary safety and efficacy of KZR-616 in the first 4 cohorts of the Phase 1b portion of Study KZR-616-002 in patients with active SLE (NCT03393013).Methods:SLE patients (per SLICC Classification Criteria) with SLEDAI ≥4 despite stable background immunosuppressant, anti-malarial, and/or corticosteroid (≤20 mg prednisone equivalent) therapy in this open-label multicentric dose-escalation trial received KZR-616 at doses of 45mg (Cohort 1), 60mg (Cohort 2), or 30mg with escalation to 60mg (Cohorts 2a and 2b) SC weekly through Week 13 (W13) with 12 weeks of follow-up. Efficacy measures included SLEDAI, Cutaneous Lupus Erythematous Disease Area and Severity Index, 28 tender and swollen joint counts, Physicians Global Assessment, Patient Global Assessment, and Patient Assessment of Pain, in evaluable patients (those who received ≥1 month of KZR-616).Results:As of 16 January 2020, 33 patients had enrolled and received at least 1 dose of KZR-616. The majority of TEAEs have been mild or moderate with no reported peripheral neuropathy, prolonged GI-related AEs, and no clinically significant laboratory AEs. There were 3 treatment emergent SAEs, one each of thrombotic microangiopathy (Cohort 2), localized herpes zoster (Cohort 2a), and systemic inflammatory response syndrome (Cohort 2a) with the latter 2 patients completing the full 13 weeks of treatment after resolution. When compared to baseline, improvement in all measures of disease activity were seen at W13 and maintained or improved during the follow-up period, and 94% of evaluable patients had improvements on at least 2 measures/assessments of disease activity. A single patient with active class IV/V nephritis was enrolled on prednisone 10 mg, leflunomide 10 mg, and hydroxychloroquine 200mg/day; nephrotic-range proteinuria at baseline (3.85 g/day) decreased to 0.6 g/day 4 weeks after the last dose of KZR-616.Conclusion:Weekly subcutaneous administration of KZR-616 at 45 and 60 mg was safe and well-tolerated. Evidence of disease suppression at W13 in active SLE patients on stable background therapy was observed. In addition, one study participant with active proliferative nephritis was enrolled with significant reduction in proteinuria. The Phase 2 portion of this study in active proliferative LN is open for enrollment.References:[1]Scott K.et al.Cochrane Database Syst Rev 2016;4:CD010816[2]Alexander Tet al.Ann Rheum Dis 2015;74: 1474–8[3]Muchamuel T.et al.Ann Rheum Dis 2018;77: A685[4]Lickliter J.et al.Ann Rheum Dis 2018;77: A1413[5]Furie Ret al.Ann Rheum Dis 2019;78: A776Disclosure of Interests:Richard Furie Grant/research support from: AstraZeneca, Biogen, Consultant of: AstraZeneca, Biogen, SV Parikh Grant/research support from: Aurinia Pharmaceuticals, EMD-Serono, Consultant of: Aurinia, BMS, GSK, Adonis Maiquez: None declared, Amber Khan: None declared, Orlando Moreno: None declared, Miguel Soneira: None declared, Christopher Kirk Shareholder of: Kezar Life Sciences, LLC, Employee of: Kezar Life Sciences, LLC, Darrin Bomba Shareholder of: Kezar Life Sciences, LLC, Employee of: Kezar Life Sciences, LLC, Ken Harvey Shareholder of: Kezar Life Sciences, LLC, Employee of: Kezar Life Sciences, LLC, Mary Katherine Farmer Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences
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Owens R, Cox C, Gomberg S, Pan S, Radhakrishna G, Parikh S, Goody R, Hingorani M, Prince S, Bird T, Dorey N, Macgregor U, Al-Chamali H, Hurt C, Mukherjee S. Outcome of Weekly Carboplatin-Paclitaxel-based Definitive Chemoradiation in Oesophageal Cancer in Patients Not Considered to be Suitable for Platinum-Fluoropyrimidine-based Treatment: A Multicentre, Retrospective Review. Clin Oncol (R Coll Radiol) 2020; 32:121-130. [PMID: 31662220 DOI: 10.1016/j.clon.2019.09.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
Abstract
AIMS Although cisplatin-fluoropyrimidine-based definitive chemoradiotherapy (dCRT) is a standard of care for oesophageal cancer, toxicity is significant and limits its use in elderly and frail patients. Weekly carboplatin-paclitaxel-based dCRT provides a viable alternative, although prospective data are lacking in the dCRT setting. Here we report the results of a national, multicentre retrospective review of outcome in patients treated with weekly carboplatin-paclitaxel-based dCRT. MATERIALS AND METHODS In this multicentre retrospective study of nine radiotherapy centres across the UK we evaluated the outcome of patients who had non-metastatic, histologically confirmed carcinoma of the oesophagus (adenocarcinoma, squamous cell or undifferentiated; World Health Organization performance status 0-2; stage I-III disease) and had been selected to receive weekly carboplatin-paclitaxel-based dCRT as they were considered not suitable for cisplatin-fluoropyrimidine-based dCRT. dCRT consisted of carboplatin AUC 2 and paclitaxel 50 mg/m2 (days 1, 8, 15, 22, 29) and the recommended radiation dose was 50 Gy in 25 daily fractions. We assessed overall survival, progression-free survival (PFS; overall, local and distant), proportion of patients who were failure free at the response assessment (12 weeks after dCRT), treatment compliance and toxicity. RESULTS In total, 214 patients from nine UK centres were treated between 15 February 2013 and 19 March 2019: 39.7% of patients were ≥75 years; 18.7% ≥ 80 years. Indications for weekly carboplatin-paclitaxel-based dCRT were comorbidities (47.2%), clinician choice (36.4%) and poor tolerance/progression on cisplatin-fluoropyrimidine induction chemotherapy (15.8%). The median overall survival was 24.28 months (95% confidence interval 20.07-30.09) and the median PFS was 16.33 months (95% confidence interval 14.29-20.96). Following treatment, 69.1% (96/139) had a combined complete response on endoscopy with non-progression (complete response/partial response/stable disease) on imaging. The 1- and 2-year overall survival rates for this patient group were 81.9% (95% confidence interval 75.6-86.8%) and 50.6% (95% confidence interval 40.5-60.0%), respectively. Thirty-three per cent (n = 70) of patients experienced at least one grade 3 + acute toxicity (grade 3/4 haematological: 10%; grade 3/4 non-haematological: 32%) and there were no treatment-related deaths. 86.9% of patients completed at least four cycles of concomitant weekly carboplatin-paclitaxel-based chemotherapy and planned radiotherapy was completed in 97.7% (209/214). CONCLUSION Weekly carboplatin-paclitaxel-based CRT seems to be well tolerated in elderly patients and in those with comorbidities, where cisplatin-fluoropyrimidine-based dCRT is contraindicated. Survival outcomes are comparable with cisplatin-fluoropyrimidine-based dCRT.
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Affiliation(s)
- R Owens
- Oxford University Hospital NHS Foundation Trust, Oxford, UK.
| | - C Cox
- Cardiff University, Centre for Trials Research, Cardiff, UK
| | - S Gomberg
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Pan
- Christie NHS Foundation Trust, Manchester, UK
| | | | - S Parikh
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Goody
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Hingorani
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Prince
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T Bird
- Royal Marsden NHS Foundation Trust, London, UK
| | - N Dorey
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | - C Hurt
- Cardiff University, Centre for Trials Research, Cardiff, UK
| | - S Mukherjee
- Oxford University Hospital NHS Foundation Trust, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
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Parikh S, Patel NR, Namaky DD, Schnettler W. Interval Robotac: Herlyn-Werner-Wunderlich Syndrome. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Parikh S, Murray L, Kenning L, Bottomley D, Din O, Dixit S, Ferguson C, Handforth C, Joseph L, Mokhtar D, White L, Wright G, Henry A. Real-world Outcomes and Factors Predicting Survival and Completion of Radium 223 in Metastatic Castrate-resistant Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:548-555. [DOI: 10.1016/j.clon.2018.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/16/2018] [Accepted: 05/20/2018] [Indexed: 01/04/2023]
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Bikdeli B, Lobo JL, Jimenez D, Green P, Fernandez-Capitan C, Bura-Riviere A, Otero R, Ditullio M, Galindo S, Ellis M, Parikh S, Monreal M. P1627Early use of echocardiography in patients with acute pulmonary embolism: findings from the RIETE registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Bikdeli
- Columbia University Medical Center, Division of Cardiology; Center for Outcomes Research and Evaluation, Yale School of Medicine; CRF, New York, United States of America
| | - J L Lobo
- University Hospital of Araba, Alava, Spain
| | - D Jimenez
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - P Green
- Columbia University Medical Center, New York, United States of America
| | | | - A Bura-Riviere
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - R Otero
- University Hospital of Virgen del Rocio, Seville, Spain
| | - M Ditullio
- Columbia University Medical Center, New York, United States of America
| | - S Galindo
- S&H Medical Sciences Services, Madrid, Spain
| | - M Ellis
- Meir Medical Center, Kfar Saba, Israel
| | - S Parikh
- Columbia University Medical Center, New York, United States of America
| | - M Monreal
- Germans Trias i Pujol Hospital, Badalona (Barcelona), Spain
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Meara A, Davidson N, Steigelman H, Zhao S, Brock G, Jarjour WN, Rovin BH, Madhoun H, Parikh S, Hebert L, Ayoub I, Ardoin SP. Screening for cognitive impairment in SLE using the Self-Administered Gerocognitive Exam. Lupus 2018; 27:1363-1367. [PMID: 29466913 DOI: 10.1177/0961203318759429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can affect the central nervous system in multiple ways, including causing cognitive dysfunction. Cognitive dysfunction is a common complaint of SLE patients yet diagnosis is challenging, time consuming, and costly. This study evaluated the Self-Administered Gerocognitive Exam (SAGE) as a screening test for cognitive impairment in a cohort of SLE patients. Methods A total of 118 SLE patients completed the SAGE. Providers completed the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the Systemic Lupus International Collaborative Clinics Damage Index (SLICC-DI). SAGE scores were grouped into normal (>16) and abnormal (≤16) categories. Univariate and multivariate analyses were performed. Results Of the 118 participants, 21(18%) scored ≤16 on the SAGE instrument. In univariate analysis, race, ethnicity, household income, and SLICC-DI scores were associated with the SAGE ( p < 0.05). In multivariable analysis, abnormal SAGE score was independently associated with higher SLICC-DI score (odds ratio (OR) = 1.44, 95% confidence intervals 1.04-1.99, p = 0.03)), Hispanic ethnicity (OR = 43.4, 95% CI 3.1-601, p = 0.005), and lower household income (OR = 11.9 for ≤$15,000 vs >$50,000, 95% CI 2.45-57, p = 0.002). Conclusions In SLE patients, this study demonstrates an independent relationship between neurocognitive impairment (as measured by the SAGE) and higher lupus-related damage, as measured by the SLICC-DI, and lower household income. Abnormal SAGE scores were also associated with Hispanic ethnicity. A language barrier could explain this because the SAGE instrument was conducted in English only. The SAGE was feasible to measure in the clinic setting.
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Affiliation(s)
- A Meara
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - N Davidson
- 1 The Ohio State University College of Medicine, Columbus, OH, USA
| | - H Steigelman
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - S Zhao
- 3 The Ohio State University Center for Biostatistics, Columbus, OH, USA
| | - G Brock
- 3 The Ohio State University Center for Biostatistics, Columbus, OH, USA
| | - W N Jarjour
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - B H Rovin
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - H Madhoun
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - S Parikh
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - L Hebert
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - I Ayoub
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
| | - S P Ardoin
- 2 The Ohio State University Department of Internal Medicine, Division of Rheumatology Immunology, Columbus, OH, USA
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Mason JA, Parikh S, Tran H, Rowell J, McRae S. Australian multicentre study of current real-world prophylaxis practice in severe and moderate haemophilia A and B. Haemophilia 2018; 24:253-260. [PMID: 29314552 DOI: 10.1111/hae.13375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION With the emergence of novel treatment products for haemophilia and an increasing focus on the benefits of pharmacokinetic driven individualized prophylaxis, robust national data with regard to current patterns of factor consumption and adherence are required. AIM To characterize current Australian practice with regard to use of prophylactic clotting factor infusions in patients with moderate or severe haemophilia A (HA) and haemophilia B (HB). METHODS This was a retrospective, non-interventional study utilizing Australian Bleeding Disorder Registry (ABDR) data collected over a 12 month period. Registered and consented patients with moderate or severe HA or HB without inhibitors were included. RESULTS A total of 718 HA (551 severe, 167 moderate) and 166 HB (87 severe, 79 moderate) patients were included. Regular prophylaxis was prescribed in 453 patients (82%) with severe HA, 42 patients (25%) with moderate HA, 66 patients (75%) with severe HB and 11 patients (14%) with moderate HB. Near universal prophylaxis was achieved in the paediatric subgroup. The mean weekly dose of factor VIII in severe HA was 84 international units/kg/wk (IU/kg/wk) vs 71 IU/kg/wk of factor IX in severe HB. Most patients on prophylaxis were treated ≥3 times/wk (HA) or 2 times/wk (HB). Non-adherence peaked in the 20-29 year age group. Older individuals on regular prophylaxis used more factor than was expected for their prescribed regimen. CONCLUSION Prophylaxis rates in severe haemophilia are comparable with other developed nations. The benefit of a national registry is demonstrable. Furthermore research into the underlying reasons for non-compliance in young adults with haemophilia is required.
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Affiliation(s)
- J A Mason
- Australian Haemophilia Centre Directors Organisation (AHCDO), Melbourne, Vic., Australia.,Queensland Haemophilia Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - S Parikh
- Australian Haemophilia Centre Directors Organisation (AHCDO), Melbourne, Vic., Australia
| | - H Tran
- Australian Haemophilia Centre Directors Organisation (AHCDO), Melbourne, Vic., Australia.,Ronald Sawyers Haemophilia Centre, The Alfred Hospital, Melbourne, Vic., Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Vic., Australia
| | - J Rowell
- Australian Haemophilia Centre Directors Organisation (AHCDO), Melbourne, Vic., Australia.,Queensland Haemophilia Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - S McRae
- Australian Haemophilia Centre Directors Organisation (AHCDO), Melbourne, Vic., Australia.,Queensland Haemophilia Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Department of Haematology, South Australia Pathology, Royal Adelaide Hospital, Adelaide, SA, Australia
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Patel P, Goyal S, Suryanarayana U, Anand A, Panchal H, Patel A, Parikh S. Results of patients of locally advanced nasopharyngeal carcinoma treated with neoadjuvant chemotherapy or upfront concurrent chemoradiotherapy: A regional cancer centre experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx665.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Parikh S, Dawe E, Lee C, Whitehead-Clarke T, Smith C, Bendall S. A cadaveric study showing the anatomical variations in the branches of the dorsalis pedis artery at the level of the ankle joint and its clinical implication in ankle arthroscopy. Ann R Coll Surg Engl 2017; 99:286-288. [PMID: 27659360 PMCID: PMC5449669 DOI: 10.1308/rcsann.2016.0288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Accepted: 07/31/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Pseudoaneurysm formation following ankle arthroscopy is a rare but potentially catastrophic complication. The placement of anterior ankle portals carries inherent risk to the superficial and deep peroneal nerves, as well as to the dorsalis pedis artery. Anatomical variations in the dorsalis pedis and the presence of branches at the joint line may increase the risk of vascular injury and pseudoaneurysm formation during arthroscopy. There is limited anatomical evidence available regarding the branches of the dorsalis pedis artery, which occur at the point at which they cross the ankle joint. Objectives The objective of the study was to describe the frequency and direction of branches of the dorsalis pedis crossing the ankle joint. Materials and Methods Nineteen cadaveric feet were carefully dissected to explore the course of the dorsalis pedis artery, noting in particular the branching pattern at the joint line. Results Eleven of the nineteen feet had a branch of the dorsalis pedis artery that crossed the level of the ankle joint. Out of these, six were lateral, four medial and one bilateral. Eight of the eleven specimens had one branch at, or just before, the level of the joint. Two specimens had two branches and one had three branches crossing the ankle, which were all in the same direction, crossing laterally to the main trunk of the dorsalis pedis. Conclusions Our study demonstrated high rates of branching of the dorsalis pedis artery at the level of the ankle joint. The role of these branches in pseudoaneurysm formation during anterior hindfoot surgery remains unclear.
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Affiliation(s)
- S Parikh
- Brighton and Sussex University Hospitals NHS Trust, Trauma and Orthopaedics , Brighton , UK
| | - E Dawe
- Brighton and Sussex University Hospitals NHS Trust, Trauma and Orthopaedics , Brighton , UK
| | - C Lee
- Brighton and Sussex University Hospitals NHS Trust, Trauma and Orthopaedics , Brighton , UK
| | - T Whitehead-Clarke
- Brighton and Sussex University Hospitals NHS Trust, Trauma and Orthopaedics , Brighton , UK
| | - C Smith
- Brighton and Sussex University Hospitals NHS Trust, Trauma and Orthopaedics , Brighton , UK
| | - S Bendall
- Brighton and Sussex University Hospitals NHS Trust, Trauma and Orthopaedics , Brighton , UK
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Leiter LA, Cefalu WT, de Bruin TWA, Xu J, Parikh S, Johnsson E, Gause-Nilsson I. Long-term maintenance of efficacy of dapagliflozin in patients with type 2 diabetes mellitus and cardiovascular disease. Diabetes Obes Metab 2016; 18:766-74. [PMID: 27009868 DOI: 10.1111/dom.12666] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/15/2016] [Accepted: 03/20/2016] [Indexed: 01/10/2023]
Abstract
AIM To evaluate the long-term efficacy, safety and tolerability of dapagliflozin versus placebo added to usual care in patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). METHODS Data were pooled from two phase III studies (NCT01031680 and NCT01042977) in high-risk patients (N = 1887) with T2DM and CVD treated with dapagliflozin (10 mg/day) or placebo. Patients completing the double-blind treatment studies (24 weeks) entered one or two sequential double-blind, long-term (LT) extensions of 28 (LT1; n = 1649) and 52 (LT2; n = 568) weeks. RESULTS Baseline and CVD characteristics were similar in the two groups. Patients entering LT1 and LT2 on dapagliflozin maintained a greater mean reduction in glycated haemoglobin (HbA1c) versus placebo at 52 weeks [LT1, -0.58% (95% confidence interval -0.68, -0.49)] and 104 weeks [LT2, -0.35% (95% confidence interval -0.59, -0.12)]. Mean body weight and systolic blood pressure (SBP) reductions versus placebo were maintained in patients entering LT1 (52 weeks; -2.23 kg and -3.25 mmHg, respectively) and LT2 (104 weeks; -3.16 kg and -2.03 mmHg, respectively). Patients on dapagliflozin had a better three-item composite endpoint of clinical benefit (glycaemia, weight and SBP) compared with placebo at week 24 (LT1, 10.1% vs. 1.1%) and week 104 (LT2, 6.7% vs. 1.4%). Genital and urinary tract infections were more frequent with dapagliflozin than with placebo. Events of hypoglycaemia, renal impairment/failure and volume depletion were similar between groups. CONCLUSIONS The long-term efficacy of dapagliflozin to maintain reductions in HbA1c, SBP and body weight over 2 years, together with its tolerability profile, make dapagliflozin an appropriate option in high-risk patients with T2DM and CVD.
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Affiliation(s)
- L A Leiter
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - W T Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - T W A de Bruin
- Research & Development, AstraZeneca, Gaithersburg, MD, USA
| | - J Xu
- Biometrics and Informatics, AstraZeneca, Gaithersburg, MD, USA
| | - S Parikh
- Global Medical Affairs-CV and Metabolism, AstraZeneca, Gaithersburg, MD, USA
| | - E Johnsson
- Research & Development, AstraZeneca Gothenburg, Mölndal, Sweden
| | - I Gause-Nilsson
- Research & Development, AstraZeneca Gothenburg, Mölndal, Sweden
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Maka VV, Pancha H, Shukla SN, Talati SS, Shah PM, Patel KM, Anand AS, Shah SA, Patel AA, Parikh S. Clinical Characteristics and prognostic analysis of Triple-negative Breast Cancer: Single institute experience. Gulf J Oncolog 2016; 1:38-44. [PMID: 27050178] [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] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is a poor prognostic subset of breast cancer that lacks the benefit of specific targeted therapy. MATERIALS AND METHODS A prospective study of the clinical profile of triple negative breast cancer cases at a tertiary referral centre. The duration of the study period was 26 months and the median follow up period was ten months. A total of 111 invasive breast cancer patients were evaluated from 1st August 2009 to 31st October 2011. We examined TNBC patients with respect to clinicopathological parameters, adjuvant chemotherapy regimens and relapse free survival. RESULTS In our study, patients were young (median age at presentation, 47yrs), premenopausal (54%), tumour size was discordant with lymph node positivity, the histology was predominantly intraductal carcinoma (90%), histological grade higher than two (90%). Relapses were early and preferential visceral (32%) and CNS metastasises (11.7%). 91% of patients were eligible for adjuvant therapy but only 80% of the patients could complete full course of adjuvant chemotherapy. Anthracycline-based regimens (43%), sequential anthracycline and taxane-based regimen (24%) and other regimes like CMF (13%) were used as adjuvant chemotherapy in eligible TNBC patients. Median relapse free survival in patients following adjuvant chemotherapy was around 10 months at last follow-up. CONCLUSIONS Patients with TNBC have aggressive clinicopathological characteristics with early and higher rate of disease relapse and therefore derive inadequate benefit from current adjuvant chemotherapy. So, new treatment strategies in adjuvant chemotherapy for TNBC are needed.
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Affiliation(s)
- V V Maka
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - H Pancha
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - S N Shukla
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - S S Talati
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - P M Shah
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - K M Patel
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - A S Anand
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - S A Shah
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - A A Patel
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - S Parikh
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Matthaei S, Bowering K, Rohwedder K, Sugg J, Parikh S, Johnsson E. Durability and tolerability of dapagliflozin over 52 weeks as add-on to metformin and sulphonylurea in type 2 diabetes. Diabetes Obes Metab 2015. [PMID: 26212528 DOI: 10.1111/dom.12543] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS To evaluate the safety and efficacy of dapagliflozin as add-on therapy to metformin plus sulphonylurea over 52 weeks. METHODS Patients with type 2 diabetes mellitus (T2DM) using sulphonylurea and metformin received dapagliflozin 10 mg/day or placebo added to therapy for 52 weeks (24-week randomized, double-blind period plus 28-week double-blind extension). RESULTS A total of 219 patients were randomized 1 : 1 to dapagliflozin or placebo. Over 52 weeks, glycated haemoglobin (HbA1c) and fasting plasma glucose levels showed greater improvement from baseline with dapagliflozin (-0.8% and -1.5 mmol/l) than with placebo (-0.1% and 0.6 mmol/l). More patients achieved HbA1c <7.0% with dapagliflozin (27.3%) than with placebo (11.3%) at 52 weeks. Dapagliflozin was associated with greater reductions in body weight and systolic blood pressure (-2.9 kg and -1.0 mmHg) compared with placebo (-1.0 kg and 1.1 mmHg). Greater increases in total, LDL and HDL cholesterol and decreases in triglycerides were observed with dapagliflozin (3.4, 4.8, 6.9 and -8.0%, respectively) versus placebo (1.4, 0.9, 0.6 and 2.9%, respectively). Fewer patients were rescued for failing to reach glycaemic targets with dapagliflozin (9.3%) than with placebo (44.4%). Adverse events and serious adverse events were similar between groups (dapagliflozin: 69.7 and 6.4%; placebo: 73.4 and 7.3%). More hypoglycaemic events were observed with dapagliflozin (15.6%) than with placebo (8.3%). Genital infections were reported in more patients in the dapagliflozin (10.1%) than in the placebo group (0.9%) and urinary tract infection frequency was similar in the two groups (10.1 and 11.0%). CONCLUSION Dapagliflozin as add-on to metformin plus a sulphonylurea was well tolerated and improvement in glycaemic control was maintained over 52 weeks.
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Affiliation(s)
- S Matthaei
- Diabetes-Zentrum Quakenbrück, Quakenbrück, Germany
| | - K Bowering
- University of Alberta, Department of Medicine, Alberta, Canada
| | | | - J Sugg
- Formerly AstraZeneca, Wilmington, DE, USA
| | - S Parikh
- AstraZeneca, Gaithersburg, MD, USA
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Cromarty J, Parikh S, Lim WK, Acharya S, Jackson TJ. Effects of hospital-acquired conditions on length of stay for patients with diabetes. Intern Med J 2015; 44:1109-16. [PMID: 25070621 DOI: 10.1111/imj.12538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/24/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inpatients with diabetes have longer length of stays (LOS). Understanding patterns of in-hospital complications between patients with diabetes and others may reveal measures to improve patient welfare and minimise LOS. AIM This study evaluates the rates and types of hospital-acquired conditions among patients with and without diabetes and assesses any effects on LOS. METHODS A total of 47 615 admission episodes from The Northern Hospital over 12 months was reviewed. Episodes were divided into four groups: (i) patients without diabetes; (ii) patients with diabetes without end-organ sequelae (EOS); (iii) patients with diabetes with EOS; and (iv) a subset of non-diabetic patients with a Charlson Co-morbidity score ≥1 (comparison group). The Classification of Hospital Acquired Diagnoses (CHADx) was applied to the groups to compare rates and types of inpatient complications. Linear regression was used to analyse the impact of the number of CHADx on LOS. RESULTS Almost 30% of admissions of patients with diabetes and EOS had at least one CHADx, compared with 13% for non-diabetes patients and 17% for the comparison group. The types of CHADx experienced by diabetes patients with EOS were similar to the comparison group. However, rates were 10 times higher. Linear regression demonstrated diabetes patients with EOS have increased LOS and each CHADx per episode has a larger effect on LOS. CONCLUSION We demonstrate that diabetes patients have consistently higher rates of CHADx and longer LOS than similar patients with complex and chronic conditions. This provides a foundation for future studies to investigate preventative practices for this high-risk patient population.
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Affiliation(s)
- J Cromarty
- The Northern Hospital, Melbourne, Victoria, Australia; Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia
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Del Prato S, Nauck M, Durán-Garcia S, Maffei L, Rohwedder K, Theuerkauf A, Parikh S. Long-term glycaemic response and tolerability of dapagliflozin versus a sulphonylurea as add-on therapy to metformin in patients with type 2 diabetes: 4-year data. Diabetes Obes Metab 2015; 17:581-590. [PMID: 25735400 DOI: 10.1111/dom.12459] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/18/2014] [Accepted: 02/27/2015] [Indexed: 01/10/2023]
Abstract
AIMS To assess the long-term efficacy and tolerability of dapagliflozin versus glipizide as add-on to metformin in patients with inadequately controlled type 2 diabetes. METHODS The present study was an extension of an earlier randomized, double-blind, phase III study of dapagliflozin (n = 406) vs glipizide (n = 408) to 208 weeks (4 years). Patients continued to receive their assigned medication. No statistical treatment-group comparisons were calculated. RESULTS At 208 weeks, dapagliflozin compared with glipizide produced sustained reductions in glycated haemoglogin (HbA1c): -0.30% [95% confidence interval (CI), -0.51 to -0.09], in total body weight: -4.38 kg (95% CI -5.31 to -3.46) and in systolic blood pressure (SBP): -3.67 mmHg (95% CI -5.92 to -1.41). The HbA1c coefficient of failure was significantly lower for dapagliflozin than for glipizide: 0.19 (95% CI 0.12-0.25) versus 0.61 (95% CI 0.49-0.72, difference -0.42; p = 0.0001). Dapagliflozin was not associated with glomerular function deterioration, while this occurred more frequently in patients in the glipizide group. Fewer patients reported hypoglycaemia in the dapagliflozin compared with the glipizide group (5.4 vs 51.5%). Genital and urinary tract infections were more common with dapagliflozin than with glipizide, but their incidence decreased with time and all events responded well to antimicrobial treatment. CONCLUSIONS In patients completing 4 years of treatment, dapagliflozin was well tolerated and associated with sustained glycaemic efficacy and greater reductions in body weight and SBP versus glipizide.
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Affiliation(s)
- S Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Nauck
- Diabetes Centre, Bad Lauterberg, Germany
| | | | - L Maffei
- CADE-ICA, Buenos Aires, Argentina
| | | | | | - S Parikh
- AstraZeneca, Gaithersburg, MD, USA
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Parikh S, Lee T, Guy E, Edwards C, Adams A, Denton M. WS13.3 Impact of implementation of enhanced infection control and early eradication regimen for Mycobacterium abscessus infection in children with cystic fibrosis. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cromarty JE, Parikh S, Jackson TJ, Lim WK, Acharya S. Author reply: To PMID 25070621. Intern Med J 2015; 45:595. [PMID: 25955476 DOI: 10.1111/imj.12750] [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] [Received: 03/03/2015] [Accepted: 03/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J E Cromarty
- Northern Clinical Research Centre, The Northern Hospital, Melbourne, Victoria, Australia
| | - S Parikh
- Northern Clinical Research Centre, The Northern Hospital, Melbourne, Victoria, Australia
| | - T J Jackson
- Northern Clinical Research Centre, The Northern Hospital, Melbourne, Victoria, Australia
| | - W K Lim
- Aged Care Department, The Northern Hospital, Melbourne, Victoria, Australia
| | - S Acharya
- John Hunter Hospital, Newcastle, New South Wales, Australia
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Sambol NC, Yan L, Creek DJ, McCormack SA, Arinaitwe E, Bigira V, Wanzira H, Kakuru A, Tappero JW, Lindegardh N, Tarning J, Nosten F, Aweeka FT, Parikh S. Population Pharmacokinetics of Piperaquine in Young Ugandan Children Treated With Dihydroartemisinin-Piperaquine for Uncomplicated Malaria. Clin Pharmacol Ther 2015; 98:87-95. [PMID: 25732044 DOI: 10.1002/cpt.104] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 01/09/2023]
Abstract
This prospective trial investigated the population pharmacokinetics of piperaquine given with dihydroartemisinin to treat uncomplicated malaria in 107 Ugandan children 6 months to 2 years old, an age group previously unstudied. Current weight-based dosing does not adequately address physiological changes in early childhood. Patients were administered standard 3-day oral doses and provided 1,282 capillary plasma concentrations from 218 malaria episodes. Less than 30% of treatments achieved 57 ng/mL on day 7. A three-compartment model with first-order absorption described the data well. Age had a statistically significant effect (P < 0.005) on clearance/bioavailability in a model that accounts for allometric scaling. Simulations demonstrated that higher doses in all children, but especially in those with lower weight for age, are required for adequate piperaquine exposure, although safety and tolerance will need to be established. These findings support other evidence that both weight- and age-specific guidelines for piperaquine dosing in children are urgently needed.
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Affiliation(s)
- N C Sambol
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA.,Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - L Yan
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA.,Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - D J Creek
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA.,Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, Victoria, Australia
| | - S A McCormack
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - E Arinaitwe
- Makerere University School of Medicine, Kampala, Uganda
| | - V Bigira
- Makerere University School of Medicine, Kampala, Uganda
| | - H Wanzira
- Makerere University School of Medicine, Kampala, Uganda
| | - A Kakuru
- Makerere University School of Medicine, Kampala, Uganda
| | - J W Tappero
- Centers for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - N Lindegardh
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J Tarning
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - F Nosten
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - F T Aweeka
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - S Parikh
- Yale School of Public Health and Medicine, New Haven, Connecticut, USA
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Hutchinson AF, Parikh S, Tacey M, Harvey PA, Lim WK. A longitudinal cohort study evaluating the impact of a geriatrician-led residential care outreach service on acute healthcare utilisation. Age Ageing 2015; 44:365-70. [PMID: 25536957 DOI: 10.1093/ageing/afu196] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 05/24/2014] [Accepted: 11/12/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND over the last decade, high demand for acute healthcare services by long-term residents of residential care facilities (RCFs) has stimulated interest in exploring alternative models of care. The Residential Care Intervention Program in the Elderly (RECIPE) service provides expert outreach services to RCFs residents, interventions include comprehensive care planning, management of inter-current illness and rapid access to acute care substitution services. OBJECTIVE to evaluate whether the RECIPE service decreased acute healthcare utilisation. DESIGN a retrospective cohort study using interrupted time series analysis to analyse change in acute healthcare utilisation before and after enrolment. SETTING a 300-bed metropolitan teaching hospital in Australia and 73 RCFs within its catchment. SUBJECTS there were 1,327 patients enrolled in the service with a median age of 84 years; 61% were female. METHODS data were collected prospectively on all enrolled patients from 2004 to 2011 and linked to the acute health service administrative data set. Primary outcomes change in admission rates, length of stay and bed days per quarter. RESULTS in the 2 years prior to enrolment, the mean number of acute care admissions per patient per year was 3.03 (SD 2.9) versus post 2.4 (SD 3.3), the service reducing admissions by 0.13 admissions per patient per quarter (P = 0.046). Prior to enrolment, the mean length of stay was 8.6 (SD 11.0) versus post 3.5 (SD 5.0), a reduction of 1.5 days per patient per quarter (P = 0.003). CONCLUSIONS this study suggests that an outreach service comprising a geriatrician-led multidisciplinary team can reduce acute hospital utilisation rates.
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Affiliation(s)
- A F Hutchinson
- Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia
| | - S Parikh
- Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia
| | - M Tacey
- Northern Clinical Research Centre, Northern Health, Melbourne, Victoria, Australia Melbourne Epicentre, Royal Melbourne Hospital, Melbourne, Victoria, Australia Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - P A Harvey
- Department of Medicine and Aged Care, Northern Health, Melbourne, Victoria, Australia
| | - W K Lim
- Department of Medicine and Aged Care, Northern Health, Melbourne, Victoria, Australia Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Patel C, Sugimoto K, Shah A, Parikh S, Douard V, Inui H, Yamanouchi T, Ferraris R. Marked Hyperfructosemia without Fructose‐Induced Hyperglycemia and Diabetes in Fructokinase‐deficient Mice. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.1009.1] [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: 11/11/2022]
Affiliation(s)
- C Patel
- Dept of Pharm & PhysiolRutgers NJ Medical SchoolUnited States
| | | | - A Shah
- Dept of Pharm & PhysiolRutgers NJ Medical SchoolUnited States
| | - S Parikh
- Dept of Pharm & PhysiolRutgers NJ Medical SchoolUnited States
| | - V Douard
- Dept of Pharm & PhysiolRutgers NJ Medical SchoolUnited States
| | - H Inui
- Dept of Clinical NutrOsaka Prefecture UniversityJapan
| | | | - R Ferraris
- Dept of Pharm & PhysiolRutgers NJ Medical SchoolUnited States
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Tang W, Reele S, Hamer-Maansson JE, Parikh S, de Bruin TWA. Dapagliflozin twice daily or once daily: effect on pharmacokinetics and urinary glucose excretion in healthy subjects. Diabetes Obes Metab 2015; 17:423-5. [PMID: 25511685 DOI: 10.1111/dom.12425] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 07/16/2014] [Revised: 11/21/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022]
Abstract
The primary objective of this single-centre, open-label crossover study (NCT01072578) was to assess the effect of dapagliflozin on the amount of glucose in the blood and urine in healthy volunteers when dapagliflozin was administered once a day (10 mg) versus twice a day (5 mg every 12 h) after 5 days of dosing. At steady state, the AUC(ss)₀₋₂₄ (area under the dapagliflozin curve (0-24 hours) at steady state), C(ss,av) (average concentration at steady state) between dapagliflozin 5 mg twice daily and 10 mg once daily were similar AUC(ss)₀₋₂₄ [5 mg bid, (458.0 (28.7)) and 10 mg qd, (470.0 (28.5))] and C(ss,av) [5 mg bid 18.8 (28.9)) and 10 mg qd, (19.6(28.5))], but minimum and maximum plasma levels of dapagliflozin differed significantly. Percent inhibition of renal glucose reabsorption (%IRGRA) and total urinary glucose excretion over 24 h were similar for both doses. The relationship between the mean dapagliflozin concentration and %IRGRA and the total urinary glucose excreted was well described by a maximum effect model. The results indicate that dapagliflozin may be used for either once daily or twice daily administration.
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Affiliation(s)
- W Tang
- AstraZeneca, R&D, Wilmington, DE, USA
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Parikh S, Wilding J, Jabbour S, Hardy E. Dapagliflozin in type 2 diabetes: effectiveness across the spectrum of disease and over time. Int J Clin Pract 2015; 69:186-98. [PMID: 25438821 DOI: 10.1111/ijcp.12531] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 07/03/2014] [Accepted: 07/26/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite many available therapies, patients with type 2 diabetes mellitus (T2DM) frequently do not achieve/maintain glycaemic control. Furthermore, side effects such as hypoglycaemia and weight gain may limit therapy choices. Dapagliflozin, a selective sodium-glucose cotransporter-2 inhibitor, reduces hyperglycaemia by increasing glucosuria independently of insulin, representing a novel approach in T2DM. Dapagliflozin efficacy, safety and tolerability were evaluated across a wide range of clinical trials. METHODS Dapagliflozin 10-mg efficacy data from (i) two short-term, active-comparator studies (vs. metformin-XR over 24 weeks and vs. glipizide over 52 weeks), (ii) pooled 24-week analyses of five placebo-controlled trials (as monotherapy or add-on therapy), and (iii) long-term studies over 2 years; dapagliflozin 5- and 10-mg pooled safety data from 12 placebo-controlled trials; and cardiovascular safety and malignancy data from 19 dapagliflozin studies were evaluated. RESULTS In treatment-naïve patients (baseline HbA1c 9%), dapagliflozin reduced HbA1c (-1.45%) similarly to metformin-XR (-1.44%). In metformin-treated patients (baseline HbA1c 7.7%), dapagliflozin achieved a clinically significant reduction (-0.52%) similar to glipizide (-0.52%). In pooled 24-week analyses, dapagliflozin vs. placebo differences in HbA1c, weight and systolic blood pressure (SBP) were -0.60%, -1.61 kg and -3.6 mmHg, respectively. At 2 years, dapagliflozin vs. placebo differences in HbA1c and weight were -0.44 to -0.80% and -2.41 to -3.19 kg, respectively, and vs. glipizide, differences in HbA1c, weight, and SBP were -0.18%, -5.06 kg, and -3.89 mmHg, respectively. Major hypoglycaemia with dapagliflozin was rare (< 0.1%). Urinary tract and genital infections were more common with dapagliflozin, but responded to standard care and rarely led to study discontinuation. Events of renal failure/impairment and malignancies were rare and balanced across treatment groups. Pooled analyses did not indicate that dapagliflozin increased cardiovascular event risk. CONCLUSIONS Dapagliflozin improved glycaemic control, decreased body weight, and lowered blood pressure across the spectrum of T2DM disease, with maintenance of these benefits over time.
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Affiliation(s)
- S Parikh
- AstraZeneca, Gaithersburg, MD, USA
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Naydich B, Huisman T, Chiaramonte R, Zorn B, Feng Y, Hopko P, Arora N, Parikh S, Settle K. Capricious PSA Dynamics After Prostate Seeds Brachytherapy Complicates Interpretation of Outcome in Over 40% of Patients. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Grandy S, Hashemi M, Langkilde AM, Parikh S, Sjöström CD. Changes in weight loss-related quality of life among type 2 diabetes mellitus patients treated with dapagliflozin. Diabetes Obes Metab 2014; 16:645-50. [PMID: 24443876 DOI: 10.1111/dom.12263] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 11/04/2013] [Revised: 01/13/2014] [Accepted: 01/13/2014] [Indexed: 12/01/2022]
Abstract
AIMS This study evaluated change in health-related quality of life (HRQOL) associated with ongoing weight change among patients with type 2 diabetes mellitus (T2DM) treated with dapagliflozin, a highly selective sodium-glucose cotransporter 2 (SGLT2) inhibitor that lowers blood glucose by increasing urinary glucose excretion and is associated with body weight reductions. METHODS Patients with T2DM who had inadequate glycaemic control on metformin (MET) alone were enrolled in a 24-week, double-blind, randomized, placebo-controlled study with a 78-week extension to evaluate the effect of dapagliflozin + MET on body weight. Patients also completed the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes Weight Questionnaire-9 (SHIELD-WQ-9), a weight change-related HRQOL survey. Difference in proportions of patients treated with dapagliflozin 10 mg + MET (n = 89) or placebo + MET (n = 91) who reported improvement in HRQOL was analysed with Fisher's exact test. RESULTS Dapagliflozin patients had significantly greater weight loss than placebo patients over 102 weeks (p < 0.05). This corresponded to a numerically greater proportion of dapagliflozin-treated patients reporting ongoing weight loss and associated improvements in most HRQOL domains at three different evaluation points (weeks 24, 50 and 102) than placebo-treated patients. In a post-hoc analysis among patients who reported ongoing weight loss regardless of treatment arm, a significantly greater proportion of patients reporting weight loss versus weight gain reported improvements in physical health, self-esteem and overall HRQOL at weeks 24, 50 and 102. CONCLUSIONS Dapagliflozin-induced weight loss was associated with improvement in overall HRQOL. Overall, ongoing weight loss was associated with improvements in several HRQOL domains compared with weight gain.
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Affiliation(s)
- S Grandy
- AstraZeneca LP, Wilmington, DE, USA
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Grandy S, Langkilde AM, Sugg JE, Parikh S, Sjöström CD. Health-related quality of life (EQ-5D) among type 2 diabetes mellitus patients treated with dapagliflozin over 2 years. Int J Clin Pract 2014; 68:486-94. [PMID: 24499168 DOI: 10.1111/ijcp.12341] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 11/27/2022] Open
Abstract
AIMS This study evaluated health status and health-related quality of life (HRQOL) among patients with type 2 diabetes mellitus (T2DM) treated with dapagliflozin, a highly selective sodium-glucose co-transporter 2 (SGLT2) inhibitor that lowers blood glucose by increasing glucose excretion, in a double-blind, randomised clinical trial. METHODS Subjects with T2DM who had inadequate glycaemic control on metformin alone were enrolled in a 24-week, double-blind, randomised, placebo-controlled study with a 78-week extension period to evaluate the effect of dapagliflozin in combination with metformin. Subjects treated with dapagliflozin 10 mg + metformin (n = 89) were compared with subjects treated with placebo + metformin (n = 91) at baseline and at weeks 24, 50 and 102. EQ-5D change from baseline was derived from a repeated-measures mixed model, adjusting for baseline EQ-5D, treatment group, time point and use of rescue medication. RESULTS Mean (SD) EQ-5D index was 0.85 (0.16) and 0.82 (0.15) at baseline and 0.85 (0.19) and 0.84 (0.19) at week 102 for dapagliflozin and placebo, respectively. The model indicated no change over 102 weeks in EQ-5D index scores in either treatment group. Mean (SD) EQ-5D visual analogue scale (VAS) was 72.5 (19.5) and 73.7 (15.6) at baseline and 79.8 (13.3) and 78.2 (12.1) at week 102 for dapagliflozin and placebo, respectively. The model indicated similar small improvements in EQ-5D VAS scores in both groups over 102 weeks. CONCLUSION Patients maintained high HRQOL scores from baseline through week 102 in both treatment groups. Dapagliflozin, a novel SGLT2 inhibitor, did not adversely affect HRQOL over 2 years of treatment.
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Affiliation(s)
- S Grandy
- AstraZeneca LP, Wilmington, DE, USA
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Bolinder J, Ljunggren Ö, Johansson L, Wilding J, Langkilde AM, Sjöström CD, Sugg J, Parikh S. Dapagliflozin maintains glycaemic control while reducing weight and body fat mass over 2 years in patients with type 2 diabetes mellitus inadequately controlled on metformin. Diabetes Obes Metab 2014; 16:159-69. [PMID: 23906445 DOI: 10.1111/dom.12189] [Citation(s) in RCA: 337] [Impact Index Per Article: 33.7] [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: 04/24/2013] [Revised: 05/26/2013] [Accepted: 07/29/2013] [Indexed: 02/06/2023]
Abstract
AIMS Dapagliflozin, a highly selective inhibitor of sodium-glucose cotransporter 2 (SGLT2), reduces hyperglycaemia and weight in patients with type 2 diabetes mellitus (T2DM) by increasing urinary glucose excretion. Long-term glycaemic control, body composition and bone safety were evaluated in patients with T2DM after 102 weeks of dapagliflozin treatment. METHODS This randomized, double-blind, placebo-controlled study (NCT00855166) enrolled patients with T2DM [mean: age 60.7 years; HbA1c 7.2%; body mass index (BMI) 31.9 kg/m(2) ; body weight 91.5 kg] inadequately controlled on metformin. Patients (N = 182) were randomly assigned 1 : 1 to receive dapagliflozin 10 mg/day or placebo added to open-label metformin for a 24-week double-blind treatment period followed by a 78-week site- and patient-blinded extension period. At week 102, changes from baseline in HbA1c, weight, waist circumference, total body fat mass as measured by dual-energy X-ray absorptiometry (DXA), serum markers of bone turnover, bone mineral density (BMD) as measured by DXA, and adverse events were evaluated. RESULTS A total of 140 patients (76.9%) completed the study. Over 102 weeks, dapagliflozin-treated patients showed reductions in HbA1c by -0.3%, weight by -4.54 kg, waist circumference by -5.0 cm and fat mass by -2.80 kg without increase in rate of hypoglycaemia. Compared with placebo, no meaningful changes from baseline in markers of bone turnover or BMD were identified over 102 weeks. One fracture occurred in each treatment group. The frequency of urinary tract infection (UTI) and genital infection was similar in both treatment groups. CONCLUSIONS Over 102 weeks, dapagliflozin improved glycaemic control, and reduced weight and fat mass, without affecting markers of bone turnover or BMD in patients with T2DM inadequately controlled on metformin.
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Affiliation(s)
- J Bolinder
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm, Sweden
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Wilding JPH, Woo V, Rohwedder K, Sugg J, Parikh S. Dapagliflozin in patients with type 2 diabetes receiving high doses of insulin: efficacy and safety over 2 years. Diabetes Obes Metab 2014; 16:124-36. [PMID: 23911013 DOI: 10.1111/dom.12187] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/21/2013] [Accepted: 07/18/2013] [Indexed: 12/13/2022]
Abstract
AIMS Dapagliflozin, a selective inhibitor of sodium-glucose cotransporter 2 (SGLT2), has been shown to improve glycaemic control, stabilize insulin dosing and mitigate insulin-associated weight gain over 48 weeks in patients whose type 2 diabetes mellitus (T2DM) was inadequately controlled despite high doses of insulin. Here the efficacy and safety of dapagliflozin therapy after a total of 104 weeks are evaluated in this population. METHODS This was a 24-week, randomized, placebo-controlled, double-blinded, multicentre trial followed by two site- and patient-blinded extension periods of 24 and 56 weeks (NCT00673231), respectively. A total of 808 patients, whose T2DM was inadequately controlled on insulin ≥30 IU/day, with or without up to two oral antidiabetic drugs, were randomly assigned to receive placebo or 2.5, 5 or 10 mg/day of dapagliflozin for 104 weeks. At 48 weeks, patients on dapagliflozin 5 mg were switched to 10 mg. Outcomes over 104 weeks included change from baseline in HbA1c, insulin dose and body weight; analyses used observed cases and included data after insulin up-titration. Adverse events (AEs) were evaluated throughout 104 weeks. RESULTS Five hundred and thirteen patients (63.6%) completed the study. Mean HbA1c changes from baseline at 104 weeks were -0.4% in the placebo group and -0.6 to -0.8% in the dapagliflozin groups. In the placebo group, mean insulin dose increased by 18.3 IU/day and weight increased by 1.8 kg at 104 weeks, whereas in the dapagliflozin groups, insulin dose was stable and weight decreased by 0.9-1.4 kg. AEs, including hypoglycaemia, were balanced across groups. Proportions of patients with events suggestive of genital infection and of urinary tract infection (UTI) were higher with dapagliflozin versus placebo (genital infection 7.4-14.3% vs. 3.0%; UTI 8.4-13.8% vs. 5.6%) but most occurred in the first 24 weeks and most were single episodes that responded to routine management. CONCLUSIONS Dapagliflozin improved glycaemic control, stabilized insulin dosing and reduced weight without increasing major hypoglycaemic episodes over 104 weeks in patients whose T2DM was inadequately controlled on insulin. However, rates of genital infection and of UTI were elevated with dapagliflozin therapy.
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Affiliation(s)
- J P H Wilding
- Diabetes and Endocrinology Research Group, Department of Obesity & Endocrinology, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
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Abstract
BACKGROUND/AIMS Corneal neovascularisation (CoNV) can lead to significant ocular comorbidity with reduction in vision and cosmesis. A number of techniques have been described to reduce CoNV, but these can be expensive. Our study aimed to determine the safety, efficacy and long-term outcomes of fine needle diathermy (FND) for CoNV. METHODS A 5-year retrospective study identified all cases of FND. Indications, intraoperative complications, and postoperative visual acuity, after treatment and retreatments, were documented, along with the procedure time. Evidence of regression and number of retreatments were identified. RESULTS 56 eyes from 52 patients underwent FND for CoNV. The main indications included herpes simplex keratitis (HSK) (53%, n=25) and microbial keratitis/peripheral ulcerative keratitis (13%, n=6). Pretreatment acuity was significantly correlated with extent of CoNV (p=0.044). One complication was noted during the procedure-an intrastromal and subconjunctival haemorrhage (rate 2%). 68.1% of patients demonstrated regression at first follow-up (mean 6.9 weeks), and 89.3% (n=42) showed regression with two or less treatments. Mean post-FND acuity was 0.72 (range -0.2-3.0) vs 0.82 (-0.2-3.0) preprocedure (p=0.08). VA improved in the HSK subgroup (p=0.012). Mean follow-up was 18.9 months (range 1-56 months). CONCLUSIONS In the largest case series reported, FND appears to be a safe and effective technique in the long term to induce regression of CoNV, with significant improvement in the VA of patients with HSK.
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Affiliation(s)
- S Trikha
- Department of Ophthalmology, University Hospital Southampton, , Southampton, UK
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Aboltins C, Dowsey MM, Peel T, Lim WK, Parikh S, Stanley P, Choong PF. Early prosthetic hip joint infection treated with debridement, prosthesis retention and biofilm-active antibiotics: functional outcomes, quality of life and complications. Intern Med J 2013; 43:810-5. [DOI: 10.1111/imj.12174] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 04/23/2013] [Indexed: 01/16/2023]
Affiliation(s)
| | - M. M. Dowsey
- Department of Orthopaedics and University of Melbourne Department of Surgery; St Vincent's Hospital
| | - T. Peel
- Department of Orthopaedics and University of Melbourne Department of Surgery; St Vincent's Hospital
| | - W. K. Lim
- University of Melbourne Department of Medicine; Northern Health
| | - S. Parikh
- Clinical Research Centre; Northern Health; Melbourne; Victoria; Australia
| | - P. Stanley
- Department of Infectious Diseases; St Vincent's Hospital
| | - P. F. Choong
- Department of Orthopaedics and University of Melbourne Department of Surgery; St Vincent's Hospital
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Abstract
Tuberculosis can involve any part of the gastrointestinal tract from mouth to anus, the peritoneum and the pancreatobiliary system. Here we report a case of splenic tuberculosis in a 60-year-old man who presented with ascitis. Splenic tuberculosis is an unusual clinical presentation, especially in immunocompetent patients. No primary focus of infection was detected in the lungs or any other organs. The postulated mechanisms by which the tubercule bacilli reach the peritoneum is through direct spread from adjacent organs like spleen in this case.
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Affiliation(s)
- Y Lonkar
- Department of Medicine, Jawahar Lal Nehru Medical College, DMIMS, Sawangi, Wardha, Maharashtra, India
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