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Palmer D, Ross P, Shah T, Yu D, Shergill S, Patterson K, Brereton N, Lee D. Cost effectiveness of selective internal radiation therapy (SIRT) with Y-90 resin microspheres versus sorafenib in Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma patients in the UK. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Frizziero M, Wang X, Chakrabarty B, Childs A, Luong T, Walter T, Elshafie M, Shah T, Fulford P, Minicozzi A, Mansoor W, Meyer T, Hubner R, Valle J, McNamara M. Mixed adeno-neuroendocrine carcinoma (MANEC) of the gastroenteropancreatic (GEP) tract: A multicentre retrospective study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx368.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Shah B, Shah T. Selection of Hospice Electronic Medical Record (EMR) for Low Income
Country: A Case Study. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shah T, O’Keefe A, Gao C, Manning T, Peacocke A, Cashman S, Shakir T, Nambiar A, Lamb B, Cumberbatch M, Pickard R, Erotocritou P, Smith D, Kasivisvanathan V. A multi-centre cohort study evaluating the role of inflammatory markers in patient’s presenting with acute ureteric colic (MIMIC). ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1569-9056(17)30474-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Montgomery RA, Orandi BJ, Racusen L, Jackson AM, Garonzik-Wang JM, Shah T, Woodle ES, Sommerer C, Fitts D, Rockich K, Zhang P, Uknis ME. Plasma-Derived C1 Esterase Inhibitor for Acute Antibody-Mediated Rejection Following Kidney Transplantation: Results of a Randomized Double-Blind Placebo-Controlled Pilot Study. Am J Transplant 2016; 16:3468-3478. [PMID: 27184779 DOI: 10.1111/ajt.13871] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/22/2016] [Accepted: 05/09/2016] [Indexed: 01/25/2023]
Abstract
Antibody-mediated rejection (AMR) is typically treated with plasmapheresis (PP) and intravenous immunoglobulin (standard of care; SOC); however, there is an unmet need for more effective therapy. We report a phase 2b, multicenter double-blind randomized placebo-controlled pilot study to evaluate the use of human plasma-derived C1 esterase inhibitor (C1 INH) as add-on therapy to SOC for AMR. Eighteen patients received 20 000 units of C1 INH or placebo (C1 INH n = 9, placebo n = 9) in divided doses every other day for 2 weeks. No discontinuations, graft losses, deaths, or study drug-related serious adverse events occurred. While the study's primary end point, a difference between groups in day 20 pathology or graft survival, was not achieved, the C1 INH group demonstrated a trend toward sustained improvement in renal function. Six-month biopsies performed in 14 subjects (C1 INH = 7, placebo = 7) showed no transplant glomerulopathy (TG) (PTC+cg≥1b) in the C1 INH group, whereas 3 of 7 placebo subjects had TG. Endogenous C1 INH measured before and after PP demonstrated decreased functional C1 INH serum concentration by 43.3% (p < 0.05) for both cohorts (C1 INH and placebo) associated with PP, although exogenous C1 INH-treated patients achieved supraphysiological levels throughout. This new finding suggests that C1 INH replacement may be useful in the treatment of AMR.
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O'Hara ME, Fernández Del Río R, Holt A, Pemberton P, Shah T, Whitehouse T, Mayhew CA. Limonene in exhaled breath is elevated in hepatic encephalopathy. J Breath Res 2016; 10:046010. [PMID: 27869108 PMCID: PMC5500822 DOI: 10.1088/1752-7155/10/4/046010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Breath samples were taken from 31 patients with liver disease and 30 controls in a clinical setting and proton transfer reaction quadrupole mass spectrometry (PTR-Quad-MS) used to measure the concentration of volatile organic compounds (VOCs). All patients had cirrhosis of various etiologies, with some also suffering from hepatocellular cancer (HCC) and/or hepatic encephalopathy (HE). Breath limonene was higher in patients with No-HCC than with HCC, median (lower/upper quartile) 14.2 (7.2/60.1) versus 3.6 (2.0/13.7) and 1.5 (1.1/2.3) nmol mol-1 in controls. This may reflect disease severity, as those with No-HCC had significantly higher UKELD (United Kingdom model for End stage Liver Disease) scores. Patients with HE were categorized as having HE symptoms presently, having a history but no current symptoms and having neither history nor current symptoms. Breath limonene in these groups was median (lower/upper quartile) 46.0 (14.0/103), 4.2 (2.6/6.4) and 7.2 (2.0/19.1) nmol mol-1, respectively. The higher concentration of limonene in those with current symptoms of HE than with a history but no current symptoms cannot be explained by disease severity as their UKELD scores were not significantly different. Longitudinal data from two patients admitted to hospital with HE show a large intra-subject variation in breath limonene, median (range) 18 (10-44) and 42 (32-58) nmol mol-1.
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Taj M, Nadeem M, Maqsood S, Shah T, Farzana T, Shamsi TS. Validation of MASCC Score for Risk Stratification in Patients of Hematological Disorders with Febrile Neutropenia. Indian J Hematol Blood Transfus 2016; 33:355-360. [PMID: 28824237 DOI: 10.1007/s12288-016-0730-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/23/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The purpose of this study is to evaluate the association of MASCC score (Multinational Association for Supportive Care in Cancer Score) in patients with febrile neutropenia (as resultant treatment of hematological disorders) for risk assessment of morbidity and mortality. PATIENTS AND METHODS Patients presenting with Febrile Neutropenia from November 2011 till December 2013 were enrolled in the study. Initially all patients were hospitalized and their MASCC score was calculated, however those with high risk stayed in hospital till full ANC recovery while low risk group was discharged earlier and keenly followed as out-patient while being on prophylactic oral antibiotics. The MASCC risk-index score was calculated and patients with risk score >21 were regarded as low-risk while <21 were labeled as high-risk. RESULTS On the basis of 226 febrile neutropenia patient 132(58.4 %) were categorized as low risk while 94(41.5 %) as high risk patients according to MASCC risk index score. In low risk group 123(93 %) had uncomplicated infection while 9(7 %) had complicated infections. There was no mortality documented in low risk group while eight patients died in high risk group. CONCLUSION In this study we correctly predicted outcome of 123(93 %) low risk group patients. The study had positive predictive value of 93 % with both sensitivity and specificity of 65 and 75 % respectively. The MASCC risk score is a valuable tool in determining the outcome in patients with febrile neutropenia.
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Bhattarai SM, Simkhada G, Shah T, Gupta RK. Laparoscopic inguinal hernia repair (total extra-peritoneal): tips and tricks. JOURNAL OF SOCIETY OF SURGEONS OF NEPAL 2016. [DOI: 10.3126/jssn.v18i3.15334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Inguinal hernia is one of the major problems at B.P. Koirala Institute of Health Sciences (BPKIHS), a tertiary referral center. We perform Laparoscopic hernia repair as a routine procedure for groin hernias. This technique is highly demanding and complex. In our country the development of laparoscopic technique is still in a developing phase.Aims and objective: To present technical tips and trick in LIHR, which we experienced, as lead to preventing intra/post operative complication.Results: We have performed a total of 129 groin hernia repairs in 105 patients with M: F= 26:1 and mean age 41.97±20 (16-85). The mean length of hospital stay was 1.14 ± 0.35 days. Eight patients were converted to TAPP and 1 converted to open hernia repair due to operative difficulty. The complications encountered are pain (20), seroma(8) and epididymitis(2).Conclusion: In our experience LIHR (TEP) is safe method for routine management of groin hernias.
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Purohit G, Shah T, Harsoda JM. Prevalence of Obesity in Medical students and its correlation with cardiovascular risk factors: Emergency Alarm for Today? Kathmandu Univ Med J (KUMJ) 2016; 13:341-5. [PMID: 27423285 DOI: 10.3126/kumj.v13i4.16834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background It is predicted that the prevalence of overweight and obesity will rise significantly by 2015 in young population. Problem of overweight and obesity has been recognized as public health problem worldwide due to the fact that it increases the risk of chronic diseases such as Cardiovascular Diseases (CVD), stroke, diabetes, sleep apnoea, osteoarthritis etc. Objective To assess the body mass index in medical students and its association with various cardiovascular risk factors like blood pressure, dietary habits, and family history of cardiovascular diseases. Method A university based cross-sectional analytical study was conducted in Department of Physiology, Smt. B.K. Shah Medical Institute and Research Center, Vadodara, Gujarat. Data was collected through convenient sampling technique by using selfadministered questionnaire followed by anthropometric measurement. Body Mass Index (BMI) of 138 first year medical students was assessed. Systolic blood pressure, diastolic blood pressure, pulse pressure, mean blood pressure, pulse rate and arterial oxygen saturation were measured. Result Data was compiled in excel sheet, analyzed for percentage and proportion. Chi square and Pearson correlation test were also applied and alpha error was set at 5% level. In comparison to the students with normal BMI, students with BMI >25 kg/m2 (N=49) showed significantly high blood pressure indices. Dietary habits and family history of cardiovascular diseases were also noted. Highly significant association of high BMI was found with elevated blood pressure (X2=7.4042***, p<0.001) and presence of family history of cardiovascular diseases X2=9.8625***, p<0.001). BMI is negatively correlated with SpO2 (r= -0.0504, p<0.05) and pulse rate, while positively correlated with systolic blood pressure (r=0.2736) and diastolic blood pressure (r=0.0275). Conclusion In conclusion, majority (more than 35%) of medical students were overweight, high prevalence of cardiovascular risk factors like family history, elevated blood pressure and less SpO2.
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Hamid S, Guillaumier S, Shah T, Arya M, Ahmed HU. Prostate cancer recurrence after Focal Therapy: Treatment options. ARCH ESP UROL 2016; 69:375-383. [PMID: 27416641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Focal therapy is a novel treatment option in localised prostate cancer with or without a visible lesion on MRI. Treatment for low to intermediate risk prostate cancer with focal therapy has demonstrated good short to medium term outcomes with fewer undesirable genitourinary side effects. This has made focal therapy more appealing to men who find the implications of radical treatment unacceptable or are unable to tolerate active surveillance. In this paper we review the literature for treatment options in prostate cancer recurrence post focal therapy. We also cover the different definitions of failure agreed upon in previous consensus meetings, as well as their implications on future management focal therapy patients.
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Ahmad A, Sheikh S, Shah T, Reddy MS, Prasad B, Verma KK, Chandrakant BB, Paithankar M, Kale P, Solanki RV, Patel R, Barkate H, Ahmad I. Endoxifen, a New Treatment Option for Mania: A Double-Blind, Active-Controlled Trial Demonstrates the Antimanic Efficacy of Endoxifen. Clin Transl Sci 2016; 9:252-259. [PMID: 27346789 PMCID: PMC5350997 DOI: 10.1111/cts.12407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/24/2016] [Indexed: 11/30/2022] Open
Abstract
The protein kinase C (PKC) signaling system plays a role in mood disorders and PKC inhibitors such as endoxifen may be an innovative medicine for bipolar disorder (BP) patients. In this study we show for the first time the antimanic properties of endoxifen in patients with bipolar I disorder (BPD I) with current manic or mixed episode. In a double-blind, active-controlled study, 84 subjects with BPD I were randomly assigned to receive endoxifen (4 mg/day or 8 mg/day) or divalproex in a 2:1 ratio. Patients orally administered 4 mg/day or 8 mg/day endoxifen showed significant improvement in mania assessed by the Young Mania Rating Scale as early as 4 days. The effect remained significant throughout the 21-day period. At study end point, response rates were 44.44% and 64.29% at 4 mg/day and 8 mg/day of endoxifen treatment, respectively. Thus, endoxifen has been shown as a promising novel antimanic or mood stabilizing agent.
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Shah T, Abu-Sanad O, Marsh H. Role of magnetic resonance imaging in the early diagnosis of paratesticular rhabdomyosarcoma. Ann R Coll Surg Engl 2016; 98:e74-6. [PMID: 27087341 PMCID: PMC5227044 DOI: 10.1308/rcsann.2016.0128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Paratesticular lesions are common, and one subgroup is paratesticular rhabdomyosarcoma. The latter is a relatively uncommon (but aggressive) tumour that affects children and adolescents predominantly. Ultrasound is the first-line investigation, but can be inconclusive. Magnetic resonance imaging (MRI) can provide useful information, but its role in the diagnosis of rhabdomyosarcoma is not clear. CASE HISTORY We report a 17-year-old male who presented with a one-month history of a rapidly enlarging, non-tender, lump in the right testicle. Urgent ultrasound of the scrotum revealed a heterogenous paratesticular mass that was hypervascular and showed calcification in the right inguinal area. MRI of the pelvis showed a solid, enhancing lesion of dimension located superior to the upper pole of the right testes and a slightly heterogeneous T2 signal, but was homogenous post-contrast. The patient underwent right radical orchidectomy, and histology results were assessed. He received chemotherapy and is being followed up. CONCLUSIONS Improvements in imaging in addition to early surgical intervention and chemotherapy treatment are crucial to improve survival chances against rhabdomyosarcoma. Ultrasound findings for benign diseases may mimic those seen in rhabdomyosarcoma. In such cases of diagnostic uncertainty, our surgical team suggest MRI to reduce the risk of a delayed diagnosis and time to treatment.
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Jensen C, Khan O, Nagras Z, Sonksen J, Fode M, Shah T, Ohl D. P-01-057 Male infertility problems of patients with sperm morphology between 5-14%. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Greulich S, Meloni A, Nazir SA, Stefan Biesbroek P, Arenja N, Kammerlander AA, Sayeed A, Ricci F, Bernhardt P, Meierhofer C, Devos DG, Ruecker B, Burkhardt B, Kamphuis VP, De Lazzari M, Nederend I, Dux-Santoy L, Cavalcante JL, Rosmini S, Liu B, Fent G, Claessen G, Behar J, Oebel S, Baritussio A, Ranjit Arnold J, Kitterer D, Latus J, Henes J, Kurmann R, Gloekler S, Wahl A, Buss S, Katus H, Bobbo M, Lombardi M, Braun N, Alscher M, Sechtem U, Mahrholdt H, Neri M, Preziosi P, Grassedonio E, Schicchi N, Keilberg P, Pulini S, Facchini E, Positano V, Pepe A, Shetye A, Khan JN, Singh A, Kanagala P, Swarbrick D, Gulsin G, Graham-Brown M, Squire I, Gershlick A, McCann GP, Amier RP, Teunissen PF, Robbers LF, Beek AM, van Rossum AC, Hofman MB, van Royen N, Nijveldt R, Riffel JH, Djiokou CN, Andre F, Fritz T, Halder M, Thomas Z, Korosoglou G, Katus HA, Buss SJ, Schwaiger ML, Duca F, Aschauer S, Marzluf BA, Zotter-Tufaro C, Dalos D, Pfaffenberger S, Bonderman D, Mascherbauer J, Fridman Y, Hackman B, Kadakkal A, Maanja M, Daya HA, Wong TC, Schelbert EB, Barison A, Todiere G, Gaeta R, Galllina S, Emdin M, De Caterina R, Aquaro G, Buckert D, Dyckmanns N, Rottbauer W, Kühn A, Shehu N, Müller J, Stern H, Ewert P, Fratz S, Vogt M, De Groote K, Babin D, Demulier L, Taeymans Y, Westenberg JJ, Van Bortel L, Segers P, Achten E, De Schepper J, Rietzschel E, Geiger J, Makki M, Burkhardt B, Kellenberger CJ, Buechel ERV, Kellenberger C, Geiger J, Ruecker B, Buechel EV, Elbaz MS, Kroft LJ, van der Geest RJ, de Roos A, Blom NA, Westenberg JJ, Roest AA, Cipriani A, Susana A, Rizzo S, Giorgi B, Carmelo L, Bertaglia E, Bauce B, Corrado D, Thiene G, Marra MP, Basso C, Iliceto S, Roest A, van den Boogaard P, ten Harkel A, de Geus J, Kroft L, de Roos A, Westenberg J, Kale R, Teixido-Tura G, Maldonado G, Huguet M, Garcia-Dorado D, Evangelista A, Rodriguez-Palomares J, Rijal S, Schindler JT, Gleason TG, Lee JS, Schelbert EB, Bulluck H, Treibel TA, Bhuva A, Abdel-Gadir A, Culotta V, Merghani A, Maestrini V, Herrey AS, Kellman P, Manisty C, Moon JC, Hayer M, Baig S, Shah T, Rooney S, Edwards N, Steeds R, Garg P, Swoboda P, Dobson L, Musa T, Foley J, Haaf P, Greenwood J, Plein S, Schnell F, Bogaert J, Dymarkowski S, Pattyn N, Claus P, Van Cleemput J, Gerche AL, Heidbuchel H, Toth D, Reiml S, Panayiotou M, Claridge S, Jackson T, Sohal M, Webb J, O'Neill M, Brost A, Mountney P, Razavi R, Rhode K, Rinaldi CA, Arya A, Hilbert S, Bollmann A, Hindricks G, Jahnke C, Paetsch I, Dinov B, Perazzolo Marra M, Ghosh Dastidar A, Rodrigues J, Zorzi A, Susana A, Scatteia A, De Garate E, Mattesi G, Strange J, Corrado D, Bucciarelli-Ducci C, Jerosch-Herold M, Karamitsos TD, Francis JM, Bhamra-Ariza P, Sarwar R, Choudhury R, Selvanayagam JB, Neubauer S. ORAL AB AGORA1362Cardiac Involvement in Patients With Different Rheumatic Disorders1366Gender differences in the development of cardiac complications: a multicentric prospective study in a large cohort of thalassemia major patients1646Comparison of T1-mapping, T2-weighted and contrast-enhanced cine imaging at 3.0T CMR for diagnostic oedema assessment in ST-segment elevation myocardial infarction1375Evaluation of Tissue Changes in Remote Noninfarcted Myocardium after Acute Myocardial Infarction using T1-mapping1377Right ventricular long axis strain – The prognostic value of a novel parameter in non-ischemic dilated cardiomyopathy using standard cardiac magnetic resonance imaging1389The role of the right ventricular insertion point in heart failure patients with preserved ejection fraction: Insights from a cardiovascular magnetic resonance study1398Myocardial fibrosis associates with B-type natriuretic peptide levels and outcomes more than wall stress1478Prognostic Value of Pulmonary Blood Volume by Contrast-Enhanced Magnetic Resonance Imaging in Heart Failure Outpatients – The PROVE-HF Study1370Magnetic Resonance Adenosine Perfusion Imaging as Gatekeeper of Invasive Coronary1509Influence of non-invasive hemodynamic CMR parameters on maximal exercise capacity in surgically untreated patients with Ebstein's anomaly1356Proximal aortic stiffening in Turner patients is more pronounced in the presence of a bicuspid valve. A segmental functional MRI study1503Flow pattern and vascular distensibility of the pulmonary arteries in patients after repair of tetralogy of Fallot. Insights from 4D flow CMR1516Myocardial deformation characteristics of the systemic right ventricle after atrial switch operation for transposition of the great arteries1633Three-dimensional vortex formation in patients with a Fontan circulation: evaluation with 4D flow CMR1483Mitral valve prolapse: arrhythmogenic substrates by cardiac magnetic imaging1596Increased local wall shear stress after coarctation repair is associated with descending aorta pulse wave velocity: evaluation with CMR and 4D flow1636Three-dimensional wall shear stress assessed by 4Dflow CMR in bicuspid aortic valve disease1464Cardiac Amyloidosis and Aortic Stenosis – The Convergence of Two Aging Processes1630Blood T1 variability explained in healthy volunteers: an analysis on MOLLI, ShMOLLI and SASHA1408Myocardial deformation on CMR predicts adverse outcomes in carcinoid heart disease - a new marker of risk1492Myocardial Perfusion Reserve and Global Longitudinal Strain in Early Rheumatoid Arthritis1500Exercise CMR to differentiate athlete's heart from patients with early dilated cardiomyopathy1559Real-Time, x-mri guidance to optimise left ventricular lead placement for delivery of cardiac resynchronisation therapy1560The role of Cardiac magnetic resonance imaging in patients undergoing ablation for ventricular tachycardia- Defining the substrate and visualizing the outcome1590Impact of cardiovascular magnetic resonance on clinical management and decision-making of out of hospital cardiac arrest survivors with inconclusive coronary angiogram1561Detection of coronary stenosis at rest using Oxygenation-Sensitive Magnetic Resonance Imaging. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kamau LM, Skilton RA, Githaka N, Kiara H, Kabiru E, Shah T, Musoke AJ, Bishop RP. Extensive polymorphism of Ra86 genes in field populations of Rhipicephalus appendiculatus from Kenya. Ticks Tick Borne Dis 2016; 7:772-781. [PMID: 27051976 DOI: 10.1016/j.ttbdis.2016.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
Commercial vaccines based on recombinant forms of the Bm86 tick gut antigen are used to control the southern cattle tick, Rhipicephalus microplus, a 1-host species, in Australia and Latin America. We describe herein sequence polymorphism in genes encoding Ra86 homologues of Bm86 in the brown ear tick, Rhipicephalus appendiculatus, isolated from four Kenyan field populations and one laboratory colony. Sequencing of 19 Ra86 sequences defined two alleles differentiated by indels, encoding 693 amino acids (aa) and 654 aa respectively, from the Muguga laboratory reference strain. Ra86 sequences were also determined from gut cDNA from four field populations of R. appendiculatus collected in different livestock production systems in Kenya. Analysis of approximately 20 Ra86 sequences from each of the four field sites in central and Western Kenya; Makuyu, Kiambu, Kakamega and Uasin Gishu, revealed three additional size types differentiated by 39-49 amino acid indels resulting in a total of 5 indel-defined genotypes. The 693 aa type 5 was isolated only from the laboratory tick stock; genotypes 1, 2 and 3 were identified in ticks from the four Kenyan field sites and appeared to be derivatives of the shorter RA86 genotype found in Muguga laboratory stock genotype 4. By contrast no large indels have yet been observed between R. microplus sequences from Australia, South America or Africa. Evidence that selection contributes to the observed sequence variation was provided by analysis of ratio of synonymous and non-synonymous substitutions and application of the selective neutrality and neutral evolution tests to the primary data. Phylogenetic analysis clustered sequences from all Ra86 size types and Bm86, into four major clades based on amino acid substitutions, but there was no evidence that these groupings correlated with geographical separation of R. appendiculatus populations.
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Peters M, Van der Voort van Zyp J, Moerland M, Hoekstra C, Van de Pol S, Westendorp H, Maenhout M, Kattevilder R, Verkooijen H, Van Rossum P, Ahmed H, Shah T, Emberton M, Van Vulpen M. PV-0038: Multivariable model development for mortality after total salvage Iodine-125 prostate brachytherapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Peters M, Van der Voort van Zyp J, Moerland M, Hoekstra C, Van de Pol S, Westendorp H, Maenhout M, Kattevilder R, Verkooijen H, Van Rossum P, Ahmed H, Shah T, Emberton M, Van Vulpen M. OC-0064: A prediction model for biochemical failure after salvage Iodine-125 prostate brachytherapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shah T, Rubenstein A. Disruption of a wire-reinforced epidural catheter upon removal: importance of having a set protocol. Int J Obstet Anesth 2016; 26:89-91. [PMID: 26975760 DOI: 10.1016/j.ijoa.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/28/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
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Jensen CFS, Ohl DA, Hiner MR, Fode M, Shah T, Smith GD, Sonksen J. Multiple needle-pass percutaneous testicular sperm aspiration as first-line treatment in azoospermic men. Andrology 2016; 4:257-62. [DOI: 10.1111/andr.12143] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 10/31/2015] [Accepted: 11/10/2015] [Indexed: 11/28/2022]
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Edwards NC, Yuan M, Nolan O, Pawade TA, Oelofse T, Singh H, Mehrzad H, Zia Z, Geh JI, Palmer DH, May CJH, Ayuk J, Shah T, Rooney SJ, Steeds RP. Effect of Valvular Surgery in Carcinoid Heart Disease: An Observational Cohort Study. J Clin Endocrinol Metab 2016; 101:183-90. [PMID: 26580239 DOI: 10.1210/jc.2015-3295] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
CONTEXT Carcinoid heart disease (NET-CHD) is associated with the development of symptom-limited exercise capacity and high rates of morbidity and mortality. OBJECTIVE This study sought to determine the survival, cardiac function, and functional class following surgery. DESIGN AND SETTING, AND PATIENTS This was a retrospective observational cohort study between 2005 and 2015 at a European Centre of Excellence for Neuroendocrine Tumours, Queen Elizabeth Hospital Birmingham. England consisting of 62 consecutive patients referred to the NET-Cardiology Service. INTERVENTIONS Subjects were assessed at referral using transthoracic echocardiography (with saline contrast) and transesophageal echocardiography, and 77% with confirmed NET-CHD underwent cardiovascular magnetic resonance imaging. Symptomatic patients with concomitant severe valvular dysfunction were referred for surgery with stable NET disease. MAIN OUTCOME MEASURE Survival of patients with proven NET-CHD following medical and surgical treatments was measure. RESULTS In total, 47/62 patients were diagnosed with NET-CHD. Thirty-two patients (68%) underwent surgery with bioprosthetic valve replacements in all subjects; tricuspid, n = 31; pulmonary, n = 30; mitral, n = 3; and aortic, n = 3. Four patients underwent concomitant coronary artery bypass grafting. There were 4 (13%) early post-operative deaths. One- and 2-y survival rates after surgery were 75 and 69% compared with 45 and 15% in un-operated patients. Post-operatively, functional class was improved (pre-New York Heart Association Classification [NYHA], 2.6 [0.5] vs post-NYHA, 1.7 [1.1]), P < .05, right-ventricular (RV) size was reduced (136 ml/m(2) [25] vs 71 ml/m(2) [7]; P < .01) with preserved RV ejection fraction (61% ± 9 vs 55% ± 10; P = .26). CONCLUSION Valve surgery improved functional class and resulted in RV reverse remodelling with improved survival rates at 2 y compared with those not proceeding to operation. These data highlight the importance of close collaboration between NET clinicians, cardiology, and cardiothoracic surgery teams. Early referral can improve functional capacity but more research is needed to define the selection of appropriate candidates and randomized data are needed to define the effect of surgery on prognosis.
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Shah T. Is prophylactic epidural blood patch the answer? Anaesthesia 2015; 70:1458-9. [PMID: 26558865 DOI: 10.1111/anae.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nandwani GM, Stoves J, Azhar MF, Pereni CI, Shah T. Metabolic abnormalities in patients treated with percutaneous nephrolithotomy. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415814556335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To assess metabolic abnormalities in patients with percutaneous nephrolithotomy (PCNL) that could pose a risk for stone recurrence. Materials and methods: The data was collected retrospectively on all patients who had PCNL and metabolic studies, between January 2000 and September 2012. Results: There were 144 patients; median age and follow up were 49.5 (15– 4) years and 80.2 (16–180) months, respectively. Nearly half of the patients had staghorn calculus. Metabolic abnormalities (MAs) were found in 55 (38.2%). The 31 (21.5%) of these had multiple metabolic abnormalities (MMA) while 24 (16.6%) had a single metabolic abnormality (SMA). Uricosuria was found in 24 (16.6%), hyperoxaluria in 22 (15.3%), hyperphosphaturia in 18 (12.5%), hypercalciuria in 10 (7%), hypomagnesuria in 6 (4.2%), cystinuria in 5 (3.5%) and hypocitraturia in 5 (3.5%). Hyperuricaemia was present in 10 (7%), hypercalcaemia in 5 (3.5%), hyperphosphataemia in 7 (5%) and renal tubular acidosis in 1 (0.7%). In non-staghorn, MAs were found in 25 (35.2%) and 16 (64%) of these had MMA. In patients with staghorn, MAs were present in 30 (41%) patients. Half of the patients 15 (50%) in this group had MMA. A high proportion of the first time stone formers requiring surgical treatment had MAs and 57% of these had MMA. Stone analysis was available for 69 (48%) and 37 (53.6%) of these had mixed composition. The highest proportion of patients with uric acid stones had MA 89% followed by cystine stones 80%, matrix stones 50%, calcium oxalate 36.6%, carbonate apatite 36.4% and triple phosphate 33.3% . Conclusion: A high proportion of first time stone formers, staghorn and non-staghorn stone formers with PCNL had MA. These findings suggest that the treatment of metabolic abnormalities can play an important role in reducing the risk of stone recurrences and management may include referral to dedicated metabolic stone clinics.
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Vu D, Shah T, Ansari J, Naraghi R, Min D. Efficacy of intravenous immunoglobulin in the treatment of persistent BK viremia and BK virus nephropathy in renal transplant recipients. Transplant Proc 2015; 47:394-8. [PMID: 25769580 DOI: 10.1016/j.transproceed.2015.01.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 01/14/2015] [Indexed: 01/26/2023]
Abstract
BK virus-associated nephropathy (BKVN) can cause clinically significant viral infection in renal transplant recipients, leading to allograft dysfunction and loss. The usual management of BKVN involves the reduction of immunosuppression and the addition of leflunomide, quinolones, and cidofovir, but the rate of graft loss remains high. The aim of this study was to assess the impact of treatment with intravenous human immunoglobulin (IVIG) on the outcome of BKVN in renal transplant recipients. Upon diagnosis of BKVN, patients remained on anti-polyomavirus treatment, consisting of the reduction of immunosuppression and the use of leflunomide therapy. Treatment with IVIG was given only to patients who did not respond to 8 weeks of the adjustment of immunosuppression and leflunomide. All 30 patients had persistent BKV viremia and BKVN with their mean BK viral loads higher than the baseline (range, 15,000-2 million copies/mL). Mean peak BK load was 205,314 copies/mL compared with 697 copies/mL after 1 year of follow-up. Twenty-seven patients (90%) had a positive response in clearing viremia. The actuarial patient and graft survival rates after 12 months were 100% and 96.7%, respectively. IVIG administration appeared to be safe and effective in treating BKV viremia and BKVN and preventing graft loss in patients who had inadequate response to immunosuppression reduction and leflunomide therapy.
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Khan O, Jensen C, Nagras Z, Sonksen J, Fode M, Shah T, Ohl D. Male infertility problems of patients with sperm morphology between 5-14%. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kanthabalan A, Shah T, Arya M, Punwani S, Bomanji J, Haroon A, Illing RO, Latifoltojar A, Freeman A, Jameson C, van der Meulen J, Charman S, Emberton M, Ahmed HU. The FORECAST study - Focal recurrent assessment and salvage treatment for radiorecurrent prostate cancer. Contemp Clin Trials 2015; 44:175-186. [PMID: 26184343 DOI: 10.1016/j.cct.2015.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/29/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND One-third of men may experience biochemical failure by 8years following radical radiotherapy for localised prostate cancer. Over 90% of men are started on androgen deprivation therapy (ADT) which is non-curative and confers systemic side-effects. Focal salvage therapy (FST) limits collateral tissue damage and may improve therapeutic ratios. In order to deliver FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected, localised and characterised. AIM FORECAST - Focal Recurrent Assessment and Salvage Treatment - is a study designed to evaluate a novel imaging-based diagnostic and therapeutic complex intervention pathway for men who fail radiotherapy. METHODS Men with biochemical failure following radical prostate radiotherapy, prior to salvage therapy will be recruited. They will undergo whole-body multi-parametric MRI (WB-MRI), choline PET/CT, bone-scan and pelvic-mpMRI and then MRI transperineal-targeted biopsies (MRI-TB) and Transperineal Template Prostate Mapping Biopsy (TPM). Those suitable for FST will undergo either high intensity focused ultrasound (HIFU) or cryotherapy. RESULTS Primary outcome measures: a) the accuracy of WB-MRI to detect distant metastatic disease; b) accuracy of prostate mpMRI in local detection of radiorecurrent prostate cancer; c) detection accuracy of MRI-TB; and d) rate of urinary incontinence following FST. CONCLUSION Focal salvage therapy may confer lower rates of morbidity whilst retaining disease control. In order to deliver FST, intra- and extra-prostatic disease must be detected early and localised accurately. Novel diagnostic techniques including WB-MRI and MRI-TB may improve the detection of distant and local disease whilst reducing healthcare burdens compared with current imaging and biopsy strategies.
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